Clinical Significance of Lipid-Rich Plaque Detected by Optical Coherence Tomography: A 4-Year Follow-Up Study

Lei Xing, Takumi Higuma, Zhao Wang, Aaron D. Aguirre, Kyoichi Mizuno, Masamichi Takano, Harold L. Dauerman, Seung Jung Park, Yangsoo Jang, Chong Jin Kim, Soo Joong Kim, So Yeon Choi, Tomonori Itoh, Shiro Uemura, Harry Lowe, Darren L. Walters, Peter Barlis, Stephen Lee, Amir Lerman, Catalin TomaJack Wei Chieh Tan, Erika Yamamoto, Krzysztof Bryniarski, Jiannan Dai, Thomas Zanchin, Shaosong Zhang, Bo Yu, Hang Lee, James Fujimoto, Valentin Fuster, Ik Kyung Jang

Research output: Contribution to journalArticle

49 Scopus citations

Abstract

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. (The Massachusetts General Hospital Optical Coherence Tomography Registry; NCT01110538)

Original languageEnglish (US)
Pages (from-to)2502-2513
Number of pages12
JournalJournal of the American College of Cardiology
Volume69
Issue number20
DOIs
StatePublished - May 23 2017

Keywords

  • atherosclerotic plaque
  • coronary artery disease
  • major adverse cardiac events
  • nonculprit plaque

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Xing, L., Higuma, T., Wang, Z., Aguirre, A. D., Mizuno, K., Takano, M., Dauerman, H. L., Park, S. J., Jang, Y., Kim, C. J., Kim, S. J., Choi, S. Y., Itoh, T., Uemura, S., Lowe, H., Walters, D. L., Barlis, P., Lee, S., Lerman, A., ... Jang, I. K. (2017). Clinical Significance of Lipid-Rich Plaque Detected by Optical Coherence Tomography: A 4-Year Follow-Up Study. Journal of the American College of Cardiology, 69(20), 2502-2513. https://doi.org/10.1016/j.jacc.2017.03.556