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

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:75

Article

Yamamoto, Myong Hwa^1,2  Maehara, Akiko^1,2  Stone, Gregg W.^1,2  Kini, Annapoorna S.³  Brilakis, Emmanouil S.^4,5,6,7  Rizik, David G.⁸  Shunk, Kendrick^9,10  Powers, Eric R.¹¹  Tobis, Jonathan M.¹²  Maini, Brijeshwar S.^13,14  Dixon, Simon R.¹⁵  Goldstein, James A.¹⁵  Petersen, John L., II¹⁶  Genereux, Philippe^2,17,18  Shah, Priti R.¹⁹  Crowley, Aaron²  Nicholls, Stephen J.²⁰  Mintz, Gary S.²  Muller, James E.²¹  Weisz, Giora^2,22 

[1] Columbia Univ, NewYork Presbyterian Hosp, Med Ctr, Div Cardiol, New York, NY USA

[2] Cardiovasc Res Fdn, Clin Trials Ctr, New York, NY USA

[3] Icahn Sch Med Mt Sinai, Mt Sinai Med Ctr, Div Cardiol, New York, NY 10029 USA

[4] Vet Affairs North Texas Hlth Care Syst, Dallas, TX USA

[5] Univ Texas Southwestern Med Ctr Dallas, Dallas, TX 75390 USA

[6] Abbott NW Hosp, Minneapolis Heart Inst, Minneapolis, MN 55407 USA

[7] Abbott NW Hosp, Minneapolis Heart Inst Fdn, Minneapolis, MN 55407 USA

[8] HonorHlth Scottsdale Shea Med Ctr, Scottsdale, AZ USA

[9] San Francisco VA Med Ctr, San Francisco, CA USA

[10] Univ Calif San Francisco, San Francisco, CA 94143 USA

[11] Med Univ South Carolina, Charleston, SC 29425 USA

[12] Univ Calif Los Angeles, Med Ctr, Los Angeles, CA 90024 USA

[13] Tenet Healthcare Corp, Delray Beach, FL USA

[14] Florida Atlantic Univ, Boca Raton, FL 33431 USA

[15] Beaumont Hosp, Royal Oak, MI USA

[16] Swedish Med Ctr, Seattle, WA USA

[17] Morristown Med Ctr, Gagnon Cardiovasc Inst, Morristown, NJ USA

[18] Hop Sacre Coeur Montreal, Montreal, PQ, Canada

[19] InfraReDx, Burlington, MA USA

[20] Monash Univ, Monash Cardiovasc Res Ctr, Melbourne, Vic, Australia

[21] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

[22] Montefiore Med Ctr, 111 E 210th St, Bronx, NY 10467 USA

关键词: intravascular ultrasound;    lipid-rich plaque;    near-infrared spectroscopy;    stent;   

DOI  :  10.1016/j.jacc.2020.01.044

来源: Elsevier

【 摘 要 】

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-tong 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 31% 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. (C) 2020 by the American College of Cardiology Foundation.

【 授权许可】

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