Impact of Lipid-Rich Plaque on Per-Vessel Outcomes in Patients Treated with Near-Infrared Spectroscopy Intravascular Ultrasound-Guided Percutaneous Coronary Intervention.

Abstract

Lipid-rich plaque detected by near-infrared spectroscopy combined with intravascular ultrasound (NIRS-IVUS) may be related to adverse outcomes after percutaneous coronary intervention (PCI). The relationship between NIRS-derived lipid burden and target vessel failure (TVF)-particularly non-target lesion failure (TLF) TVF-remains unclear.We retrospectively analyzed 151 consecutive patients (163 lesions) who underwent NIRS-IVUS-guided drug-eluting stent implantation at a single center. The maximum 4-mm lipid core burden index (MaxLCBI_4mm) was measured before and after stent implantation. Primary outcomes were TLF, TVF, and non-TLF TVF. During a median 3.1-year follow-up, TLF, TVF and non-TLF TVF occurred in 9 (5.5%), 15 (9.2%) and 6 (3.7%) lesions, respectively. Lesions with TVF demonstrated significantly greater frequency of post MaxLCBI_4mm > 400. Receiver-operating characteristic analysis identified optimal post MaxLCBI_4mm cutoff values of 289 for TVF (area under the curve [AUC] 0.65) and 408 for non-TLF TVF (AUC 0.85). Kaplan-Meier analysis showed significantly higher cumulative TVF and non-TLF TVF in lesions with post MaxLCBI_4mm > 400 (log-rank P = 0.0272 and P < 0.0001, respectively).No significant association was found between MaxLCBI_4mm and TLF.In a real-world PCI cohort, post MaxLCBI_4mm > 400 was related to TVF, especially non-TLF TVF. NIRS-IVUS may help identify patients at risk of vessel-level events despite contemporary DES implantation.