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PREVALENCE AND CLINICAL SIGNIFICANCE OF LIPID-RICH PLAQUE DETECTED BY OPTICAL COHERENCE TOMOGRAPHY: A FOUR-YEAR FOLLOW-UP STUDY
975 JACC March 21, 2017 Volume 69, Issue 11
Interventional Cardiology PREVALENCE AND CLINICAL SIGNIFICANCE OF LIPID-RICH PLAQUE DETECTED BY OPTICAL COHERENCE TOMOGRAPHY: A FOUR-YEAR FOLLOW-UP STUDY Moderated Poster Contributions Interventional Cardiology Moderated Poster Theater, Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-3:55 p.m. Session Title: The Inside View: Learning From Intracoronary Imaging Abstract Category: 23. Interventional Cardiology: IVUS and Intravascular Physiology Presentation Number: 1175M-03 Authors: Lei Xing, Takumi Higuma, Zhao Wang, Aaron Aguirre, Shaosong Zhang, Bo Yu, Hang Lee, James Fujimoto, Valentin Fuster, Ik-Kyung Jang, OCT Registry Investigators, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China Background: Lipid-rich plaque (LRP) is thought to be a precursor to cardiac events. The clinical significance of LRP has never been systematically investigated.
Methods: A total of 1474 patients undergoing PCI, who had optical coherence tomography (OCT) imaging of the target vessel were included from 20 sites across six countries. Major adverse cardiac events (MACE) were defined as a composite of cardiac death, acute myocardial infarction, and ischemia-driven revascularization. The patients were followed up to 4 years.
Results: There was no difference in cumulative rate of all MACE over 48 months between the groups (Figure A). However, the cumulative rate of non-culprit lesion related MACE (NC-MACE) over 48 months in patients with LRP was higher than in those without LRP (7.2% vs. 2.6%, p = 0.033) (Figure B). Acute coronary syndrome at index presentation (HR: 2.231, 95% CI: 1.149-4.332, p = 0.018), interruption of statin use ≥ one year (HR: 4.185, 95% CI: 1.915-9.147, p < 0.001), and LRP in non-culprit regions (HR: 2.103, 95% CI: 1.103-4.008, p = 0.024) were independently associated with increased NC-MACE. OCT findings revealed that, compared to LRPs in patients without MACE, LRPs in patients with NC-MACE had longer lipid length (p < 0.001), wider maximal lipid arc (p = 0.023), and smaller minimal lumen area (p = 0.003). Conclusions: Presence of LRP in the non-culprit regions of the target vessel by OCT predicts increased risk for future NC-MACE, which is primarily driven by revascularization for recurrent ischemia.
Interventional Cardiology PREVALENCE AND CLINICAL SIGNIFICANCE OF LIPID-RICH PLAQUE DETECTED BY OPTICAL COHERENCE TOMOGRAPHY: A FOUR-YEAR FOLLOW-UP STUDY Moderated Poster Contributions Interventional Cardiology Moderated Poster Theater, Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-3:55 p.m. Session Title: The Inside View: Learning From Intracoronary Imaging Abstract Category: 23. Interventional Cardiology: IVUS and Intravascular Physiology Presentation Number: 1175M-03 Authors: Lei Xing, Takumi Higuma, Zhao Wang, Aaron Aguirre, Shaosong Zhang, Bo Yu, Hang Lee, James Fujimoto, Valentin Fuster, Ik-Kyung Jang, OCT Registry Investigators, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China Background: Lipid-rich plaque (LRP) is thought to be a precursor to cardiac events. The clinical significance of LRP has never been systematically investigated.
Methods: A total of 1474 patients undergoing PCI, who had optical coherence tomography (OCT) imaging of the target vessel were included from 20 sites across six countries. Major adverse cardiac events (MACE) were defined as a composite of cardiac death, acute myocardial infarction, and ischemia-driven revascularization. The patients were followed up to 4 years.
Results: There was no difference in cumulative rate of all MACE over 48 months between the groups (Figure A). However, the cumulative rate of non-culprit lesion related MACE (NC-MACE) over 48 months in patients with LRP was higher than in those without LRP (7.2% vs. 2.6%, p = 0.033) (Figure B). Acute coronary syndrome at index presentation (HR: 2.231, 95% CI: 1.149-4.332, p = 0.018), interruption of statin use ≥ one year (HR: 4.185, 95% CI: 1.915-9.147, p < 0.001), and LRP in non-culprit regions (HR: 2.103, 95% CI: 1.103-4.008, p = 0.024) were independently associated with increased NC-MACE. OCT findings revealed that, compared to LRPs in patients without MACE, LRPs in patients with NC-MACE had longer lipid length (p < 0.001), wider maximal lipid arc (p = 0.023), and smaller minimal lumen area (p = 0.003). Conclusions: Presence of LRP in the non-culprit regions of the target vessel by OCT predicts increased risk for future NC-MACE, which is primarily driven by revascularization for recurrent ischemia.