Clinical significance of lipid-rich plaque detected by optical coherence tomography: a 4-year follow-up study

Xing, Lei, Higuma, Takumi, Wang, Zhao, Aguirre, Aaron D., Mizuno, Kyoichi, Takano, Masamichi, Dauerman, Harold L., Park, Seung-Jung, Jang, Yangsoo, Kim, Chong-Jin, Kim, Soo-Joong, Choi, So-Yeon, Itoh, Tomonori, Uemura, Shiro, Lowe, Harry, Walters, Darren L., Barlis, Peter, Lee, Stephen, Lerman, Amir, Toma, Catalin, Tan, Jack Wei Chieh, Yamamoto, Erika, Bryniarski, Krzysztof, Dai, Jiannan, Zanchin, Thomas, Zhang, Shaosong, Yu, Bo, Lee, Hang, Fujimoto, James, Fuster, Valentin and Jang, Ik-Kyung (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. doi:10.1016/j.jacc.2017.03.556


Author Xing, Lei
Higuma, Takumi
Wang, Zhao
Aguirre, Aaron D.
Mizuno, Kyoichi
Takano, Masamichi
Dauerman, Harold L.
Park, Seung-Jung
Jang, Yangsoo
Kim, Chong-Jin
Kim, Soo-Joong
Choi, So-Yeon
Itoh, Tomonori
Uemura, Shiro
Lowe, Harry
Walters, Darren L.
Barlis, Peter
Lee, Stephen
Lerman, Amir
Toma, Catalin
Tan, Jack Wei Chieh
Yamamoto, Erika
Bryniarski, Krzysztof
Dai, Jiannan
Zanchin, Thomas
Zhang, Shaosong
Yu, Bo
Lee, Hang
Fujimoto, James
Fuster, Valentin
Jang, Ik-Kyung
Title Clinical significance of lipid-rich plaque detected by optical coherence tomography: a 4-year follow-up study
Journal name Journal of the American College of Cardiology   Check publisher's open access policy
ISSN 1558-3597
0735-1097
Publication date 2017-05-23
Sub-type Article (original research)
DOI 10.1016/j.jacc.2017.03.556
Open Access Status Not yet assessed
Volume 69
Issue 20
Start page 2502
End page 2513
Total pages 12
Place of publication San Diego, CA, United States
Publisher Elsevier
Language eng
Subject 2705 Cardiology and Cardiovascular Medicine
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)
Formatted 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)
Keyword Atherosclerotic plaque
Coronary artery disease
Major adverse cardiac events
Nonculprit plaque
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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