Significance of Lipid-Rich Plaque Detected by OCT

Study Questions:

What is the prevalence and clinical significance of lipid-rich plaque (LRP) in the nonculprit region of the target vessel in patients undergoing percutaneous coronary intervention (PCI)?

Methods:

This was a prospective study of 1,474 patients from 20 sites across six countries who underwent optical coherence tomography (OCT) imaging of the target vessel while undergoing PCI. Major adverse cardiac events (MACE) were defined as a composite of cardiac death, acute myocardial infarction, and ischemia-driven revascularization. Patients were followed annually for 4 years and the median follow-up was 2 years.

Results:

LRP was detected in 33% of the patients and was associated with a higher likelihood of MACE (7.2% vs. 2.6, p = 0.033). Acute coronary syndrome (ACS) at index presentation (relative risk [RR], 2.538; 95% confidence interval [CI], 1.246-5.173; p = 0.010), interruption of statin use ≥1 year (RR, 4.517; 95% CI, 1.923-10.610; p = 0.001), and LRP in the nonculprit region (risk ratio, 2.061; 95% CI, 1.050-4.044; p = 0.036) were independently associated with increased MACE. Among patients with LRP, predictors of MACE included longer lipid length (p < 0.001), wider maximal lipid arc (p = 0.023), and smaller minimal lumen area (p = 0.003).

Conclusions:

LRP in the nonculprit segment of the target vessel by OCT is associated with a higher incidence of MACE on follow-up.

Perspective:

This study corroborates prior intravascular ultrasound-based studies that demonstrated a high prevalence of LRPs in patients with ACS and a higher risk of future adverse events in association with LRP. While it would be premature to prospectively screen for LRP in all patients with ACS based on these data, identification of LRP should trigger more intensive lipid-lowering and patient education to reduce the risk of future adverse events.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Aortic Surgery, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging

Keywords: Acute Coronary Syndrome, Cardiac Imaging Techniques, Coronary Artery Disease, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Ischemia, Lipids, Myocardial Infarction, Myocardial Revascularization, Percutaneous Coronary Intervention, Plaque, Atherosclerotic, Risk, Tomography, Optical Coherence


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