TY - JOUR
T1 - Impact of Lipidic Plaque on In-Stent and Stent Edge-Related Events After PCI in Myocardial Infarction
T2 - A PROSPECT II Substudy
AU - Kjøller-Hansen, Lars
AU - Maehara, Akiko
AU - Kelbæk, Henning
AU - Matsumura, Mitsuaki
AU - Maeng, Michael
AU - Engstrøm, Thomas
AU - Fröbert, Ole
AU - Persson, Jonas
AU - Wiseth, Rune
AU - Larsen, Alf Inge
AU - Jensen, Lisette Okkels
AU - Nordrehaug, Jan Erik
AU - Omerovic, Elmir
AU - Held, Claes
AU - James, Stefan
AU - Mintz, Gary S
AU - Ali, Ziad A
AU - Stone, Gregg W
AU - Erlinge, David
PY - 2024/10
Y1 - 2024/10
N2 - BACKGROUND: Lipid content in untreated nonobstructive coronary artery lesions is associated with adverse clinical outcomes, and residual in-stent or stent edge lipid may worsen outcomes after percutaneous coronary intervention (PCI).METHODS: Near-infrared spectroscopy-intravascular ultrasound was performed before and after PCI in patients with myocardial infarction. We evaluated the impact of lipid assessed by near-infrared spectroscopy (maximal lipid core burden index over 4 mm [maxLCBI4mm]) along with intravascular ultrasound information including residual plaque burden on in-stent or edge-related major adverse cardiac events (MACE) in de novo PCI-treated culprit coronary artery lesions. The primary end point was culprit lesion-related MACE (CL-MACE), defined as cardiac death, myocardial infarction, or unstable or progressive angina either requiring revascularization or with rapid lesion progression and classified as in-stent or stent edge-related.RESULTS: During a median follow-up of 3.8 years, 25 CL-MACE (11 stent edge-related, 13 in-stent, and 1 in-lesion without a stent) occurred in 1041 PCI-treated lesions in 768 patients. Pre-PCI or post-PCI measures of lipid content were not related to in-stent CL-MACE. However, stent edge-related CL-MACE was increased if both the post-PCI stent edge maxLCBI4mm was greater than the upper quartile (108.7) and the stent edge plaque burden was >50% (adjusted odds ratio, 4.11 [95% CI, 1.12-15.2]; P=0.03).CONCLUSIONS: In PROSPECT II (Providing Regional Observations to Study Predictors of Events in the Coronary Tree), CL stent implantation leaving behind greater stent edge-related lipid and uncovered plaque burden was associated with an increased risk of stent edge-related CL-MACE during follow-up. In contrast, CL lipid content was not related to in-stent CL-MACE.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02171065.
AB - BACKGROUND: Lipid content in untreated nonobstructive coronary artery lesions is associated with adverse clinical outcomes, and residual in-stent or stent edge lipid may worsen outcomes after percutaneous coronary intervention (PCI).METHODS: Near-infrared spectroscopy-intravascular ultrasound was performed before and after PCI in patients with myocardial infarction. We evaluated the impact of lipid assessed by near-infrared spectroscopy (maximal lipid core burden index over 4 mm [maxLCBI4mm]) along with intravascular ultrasound information including residual plaque burden on in-stent or edge-related major adverse cardiac events (MACE) in de novo PCI-treated culprit coronary artery lesions. The primary end point was culprit lesion-related MACE (CL-MACE), defined as cardiac death, myocardial infarction, or unstable or progressive angina either requiring revascularization or with rapid lesion progression and classified as in-stent or stent edge-related.RESULTS: During a median follow-up of 3.8 years, 25 CL-MACE (11 stent edge-related, 13 in-stent, and 1 in-lesion without a stent) occurred in 1041 PCI-treated lesions in 768 patients. Pre-PCI or post-PCI measures of lipid content were not related to in-stent CL-MACE. However, stent edge-related CL-MACE was increased if both the post-PCI stent edge maxLCBI4mm was greater than the upper quartile (108.7) and the stent edge plaque burden was >50% (adjusted odds ratio, 4.11 [95% CI, 1.12-15.2]; P=0.03).CONCLUSIONS: In PROSPECT II (Providing Regional Observations to Study Predictors of Events in the Coronary Tree), CL stent implantation leaving behind greater stent edge-related lipid and uncovered plaque burden was associated with an increased risk of stent edge-related CL-MACE during follow-up. In contrast, CL lipid content was not related to in-stent CL-MACE.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02171065.
KW - Aged
KW - Coronary Artery Disease/therapy
KW - Coronary Vessels/diagnostic imaging
KW - Female
KW - Humans
KW - Lipids
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/diagnostic imaging
KW - Percutaneous Coronary Intervention/adverse effects
KW - Plaque, Atherosclerotic
KW - Prospective Studies
KW - Risk Factors
KW - Spectroscopy, Near-Infrared
KW - Stents
KW - Time Factors
KW - Treatment Outcome
KW - Ultrasonography, Interventional
UR - http://www.scopus.com/inward/record.url?scp=85205430246&partnerID=8YFLogxK
U2 - 10.1161/CIRCINTERVENTIONS.124.014215
DO - 10.1161/CIRCINTERVENTIONS.124.014215
M3 - Journal article
C2 - 39319453
SN - 1941-7640
VL - 17
SP - e014215
JO - Circulation. Cardiovascular interventions
JF - Circulation. Cardiovascular interventions
IS - 10
ER -