2-Year Outcomes After Stenting of Lipid-Rich and Nonrich Coronary Plaques

Myong Hwa Yamamoto; Akiko Maehara; Gregg W Stone; Annapoorna S Kini; Emmanouil S Brilakis; David G Rizik; Kendrick Shunk; Eric R Powers; Jonathan M Tobis; Brijeshwar S Maini; Simon R Dixon; James A Goldstein; John L Petersen 2nd; Philippe Généreux; Priti R Shah; Aaron Crowley; Stephen J Nicholls; Gary S Mintz; James E Muller; Giora Weisz

doi:10.1016/j.jacc.2020.01.044

2-Year Outcomes After Stenting of Lipid-Rich and Nonrich Coronary Plaques

J Am Coll Cardiol. 2020 Mar 31;75(12):1371-1382. doi: 10.1016/j.jacc.2020.01.044.

Authors

Myong Hwa Yamamoto¹, Akiko Maehara², Gregg W Stone¹, Annapoorna S Kini³, Emmanouil S Brilakis⁴, David G Rizik⁵, Kendrick Shunk⁶, Eric R Powers⁷, Jonathan M Tobis⁸, Brijeshwar S Maini⁹, Simon R Dixon¹⁰, James A Goldstein¹⁰, John L Petersen 2nd¹¹, Philippe Généreux¹², Priti R Shah¹³, Aaron Crowley¹⁴, Stephen J Nicholls¹⁵, Gary S Mintz¹⁴, James E Muller¹⁶, Giora Weisz¹⁷

Affiliations

¹ Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
² Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York. Electronic address: [email protected].
³ Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York.
⁴ Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas; Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
⁵ HonorHealth Scottsdale Shea Medical Center, Scottsdale, Arizona.
⁶ San Francisco Veterans Affairs Medical Center, San Francisco, California; University of California, San Francisco, California.
⁷ Medical University of South Carolina, Charleston, South Carolina.
⁸ University of California Los Angeles Medical Center, Los Angeles, California.
⁹ Tenet Healthcare Corporation, Delray Beach, Florida; Florida Atlantic University, Boca Raton, Florida.
¹⁰ Beaumont Hospital, Royal Oak, Michigan.
¹¹ Swedish Medical Center, Seattle, Washington.
¹² Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
¹³ InfraReDx, Burlington, Massachusetts.
¹⁴ Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
¹⁵ Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia.
¹⁶ Brigham and Women's Hospital, Boston, Massachusetts.
¹⁷ Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Montefiore Medical Center, Bronx, New York.

PMID: 32216905
DOI: 10.1016/j.jacc.2020.01.044

Abstract

Background: Autopsy studies suggest that implanting stents in lipid-rich plaque (LRP) may be associated with adverse outcomes.

Objectives: The purpose of this study was to evaluate the association between LRP detected by near-infrared spectroscopy (NIRS) and clinical outcomes in patients with coronary artery disease treated with contemporary drug-eluting stents.

Methods: In this prospective, multicenter registry, NIRS was performed in patients undergoing coronary angiography and possible percutaneous coronary intervention (PCI). Lipid core burden index (LCBI) was calculated as the fraction of pixels with the probability of LRP >0.6 within a region of interest. MaxLCBI_4mm was defined as the maximum LCBI within any 4-mm-long segment. Major adverse cardiac events (MACE) included cardiac death, myocardial infarction, definite or probable stent thrombosis, or unplanned revascularization or rehospitalization for progressive angina or unstable angina. Events were subcategorized as culprit (treated) lesion-related, nonculprit (untreated) lesion-related, or indeterminate.

Results: Among 1,999 patients who were enrolled in the COLOR (Chemometric Observations of Lipid Core Plaques of Interest in Native Coronary Arteries Registry), PCI was performed in 1,621 patients and MACE occurred in 18.0% of patients, of which 8.3% were culprit lesion-related, 10.7% were nonculprit lesion-related, and 3.1% were indeterminate during 2-year follow-up. Complications from NIRS imaging occurred in 9 patients (0.45%), which resulted in 1 peri-procedural myocardial infarction and 1 emergent coronary bypass. Pre-PCI NIRS imaging was obtained in 1,189 patients, and the 2-year rate of culprit lesion-related MACE was not significantly associated with maxLCBI_4mm (hazard ratio of maxLCBI_4mm per 100: 1.06; 95% confidence interval: 0.96 to 1.17; p = 0.28) after adjusting clinical and procedural factors.

Conclusions: Following PCI with contemporary drug-eluting stents, stent implantation in NIRS-defined LRPs was not associated with increased periprocedural or late adverse outcomes compared with those without significant lipid.

Keywords: intravascular ultrasound; lipid-rich plaque; near-infrared spectroscopy; stent.

Publication types

Multicenter Study

MeSH terms

Aged
Coronary Artery Disease / diagnostic imaging*
Coronary Artery Disease / metabolism*
Drug-Eluting Stents / adverse effects
Drug-Eluting Stents / trends*
Female
Follow-Up Studies
Humans
Lipid Metabolism / physiology
Male
Middle Aged
Percutaneous Coronary Intervention / adverse effects
Percutaneous Coronary Intervention / trends*
Plaque, Atherosclerotic / diagnostic imaging*
Plaque, Atherosclerotic / metabolism*
Prospective Studies
Registries
Spectroscopy, Near-Infrared / trends
Treatment Outcome