TY - JOUR
T1 - Clinical Significance of Lipid-Rich Plaque Detected by Optical Coherence Tomography
T2 - A 4-Year Follow-Up Study
AU - Xing, Lei
AU - Higuma, Takumi
AU - Wang, Zhao
AU - Aguirre, Aaron D.
AU - Mizuno, Kyoichi
AU - Takano, Masamichi
AU - Dauerman, Harold L.
AU - Park, Seung Jung
AU - Jang, Yangsoo
AU - Kim, Chong Jin
AU - Kim, Soo Joong
AU - Choi, So Yeon
AU - Itoh, Tomonori
AU - Uemura, Shiro
AU - Lowe, Harry
AU - Walters, Darren L.
AU - Barlis, Peter
AU - Lee, Stephen
AU - Lerman, Amir
AU - Toma, Catalin
AU - Tan, Jack Wei Chieh
AU - Yamamoto, Erika
AU - Bryniarski, Krzysztof
AU - Dai, Jiannan
AU - Zanchin, Thomas
AU - Zhang, Shaosong
AU - Yu, Bo
AU - Lee, Hang
AU - Fujimoto, James
AU - Fuster, Valentin
AU - Jang, Ik Kyung
N1 - Publisher Copyright:
© 2017 American College of Cardiology Foundation
PY - 2017/5/23
Y1 - 2017/5/23
N2 - Background Lipid-rich plaque (LRP) is thought to be a precursor to cardiac events. However, its clinical significance in coronary arteries has never been systematically investigated. Objectives This study investigated the prevalence and clinical significance of LRP in the nonculprit region of the target vessel in patients undergoing percutaneous coronary intervention (PCI). Methods The study included 1,474 patients from 20 sites across 6 countries undergoing PCI, who had optical coherence tomography (OCT) imaging of the target vessel. Major adverse cardiac events (MACE) were defined as a composite of cardiac death, acute myocardial infarction, and ischemia-driven revascularization. Patients were followed for up to 4 years (median of 2 years). Results Lipid-rich plaque was detected in nonculprit regions of the target vessel in 33.6% of patients. The cumulative rate of nonculprit lesion-related MACE (NC-MACE) over 48 months in patients with LRP was higher than in those without LRP (7.2% vs. 2.6%, respectively; p = 0.033). Acute coronary syndrome at index presentation (risk ratio: 2.538; 95% confidence interval [CI]: 1.246 to 5.173; p = 0.010), interruption of statin use ≥1 year (risk ratio: 4.517; 95% CI: 1.923 to 10.610; p = 0.001), and LRP in nonculprit regions (risk ratio: 2.061; 95% CI: 1.050 to 4.044; p = 0.036) were independently associated with increased NC-MACE. Optical coherence tomography findings revealed that LRP in patients with NC-MACE had longer lipid lengths (p < 0.001), wider maximal lipid arcs (p = 0.023), and smaller minimal lumen areas (p = 0.003) than LRPs in patients without MACE. Conclusions Presence of LRP in the nonculprit regions of the target vessel by OCT predicts increased risk for future NC-MACE, which is primarily driven by revascularization for recurrent ischemia. Lipid-rich plaque with longer lipid length, wider lipid arc, and higher degree of stenosis identified patients at higher risk of future cardiac events.
AB - Background Lipid-rich plaque (LRP) is thought to be a precursor to cardiac events. However, its clinical significance in coronary arteries has never been systematically investigated. Objectives This study investigated the prevalence and clinical significance of LRP in the nonculprit region of the target vessel in patients undergoing percutaneous coronary intervention (PCI). Methods The study included 1,474 patients from 20 sites across 6 countries undergoing PCI, who had optical coherence tomography (OCT) imaging of the target vessel. Major adverse cardiac events (MACE) were defined as a composite of cardiac death, acute myocardial infarction, and ischemia-driven revascularization. Patients were followed for up to 4 years (median of 2 years). Results Lipid-rich plaque was detected in nonculprit regions of the target vessel in 33.6% of patients. The cumulative rate of nonculprit lesion-related MACE (NC-MACE) over 48 months in patients with LRP was higher than in those without LRP (7.2% vs. 2.6%, respectively; p = 0.033). Acute coronary syndrome at index presentation (risk ratio: 2.538; 95% confidence interval [CI]: 1.246 to 5.173; p = 0.010), interruption of statin use ≥1 year (risk ratio: 4.517; 95% CI: 1.923 to 10.610; p = 0.001), and LRP in nonculprit regions (risk ratio: 2.061; 95% CI: 1.050 to 4.044; p = 0.036) were independently associated with increased NC-MACE. Optical coherence tomography findings revealed that LRP in patients with NC-MACE had longer lipid lengths (p < 0.001), wider maximal lipid arcs (p = 0.023), and smaller minimal lumen areas (p = 0.003) than LRPs in patients without MACE. Conclusions Presence of LRP in the nonculprit regions of the target vessel by OCT predicts increased risk for future NC-MACE, which is primarily driven by revascularization for recurrent ischemia. Lipid-rich plaque with longer lipid length, wider lipid arc, and higher degree of stenosis identified patients at higher risk of future cardiac events.
KW - atherosclerotic plaque
KW - coronary artery disease
KW - major adverse cardiac events
KW - nonculprit plaque
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U2 - 10.1016/j.jacc.2017.03.556
DO - 10.1016/j.jacc.2017.03.556
M3 - Article
C2 - 28521888
AN - SCOPUS:85019248086
SN - 0735-1097
VL - 69
SP - 2502
EP - 2513
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 20
ER -