Murai Kota, Kataoka Yu, Nicholls Stephen J, Puri Rishi, Nakaoku Yuriko, Nishimura Kunihiro, Kitahara Satoshi, Iwai Takamasa, Sawada Kenichiro, Matama Hideo, Honda Satoshi, Fujino Masashi, Yoneda Shuichi, Takagi Kensuke, Nishihira Kensaku, Otsuka Fumiyuki, Asaumi Yasuhide, Tsujita Kenichi, Noguchi Teruo
Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Can J Cardiol. 2022 Oct;38(10):1504-1515. doi: 10.1016/j.cjca.2022.07.004. Epub 2022 Jul 14.
Lipid-rich plaque is an important substrate that causes future coronary events. However, the clinical implications of underlying plaque characteristics in coronary lesions after newer-generation drug-eluting stent (DES) implantation remain unknown.
The current study analyzed 445 target lesions after newer-generation DES implantation in 416 patients with coronary artery disease (CAD) (chronic coronary syndrome/acute coronary syndrome = 264/181) from the REASSURE-NIRS multicentre registry. Near-infrared spectroscopy (NIRS) imaging was used to evaluate maximum lipid core burden index after stent implantation in target lesions (residual maxLCBI). The primary and secondary outcomes were 3-year lesion-oriented clinical outcomes (LOCO): cardiac death, nonfatal target-lesion-related myocardial infarction (MI), or ischemia-driven target-lesion revascularization (ID-TLR) and patient-oriented clinical outcomes (POCO): all-cause death, nonfatal MI, or ID unplanned revascularization. Outcomes were compared by residual maxLCBI tertile.
Median residual maxLCBI was 183; 16% of lesions had residual maxLCBI > 400. Higher residual maxLCBI was not associated with a greater likelihood of LOCO or POCO during the observational period (LOCO, log-rank P = 0.76; POCO, log-rank P = 0.84). Mixed-effects logistic regression demonstrated that residual maxLCBI does not predict LOCO (odds ratio [OR], 1.000; 95% confidence interval [CI], 0.997-1.003; P = 0.95). There was no significant relationship between residual maxLCBI and POCO (OR, 1.001; 95% CI, 0.999-1.002; P = 0.30).
Residual maxLCBI is not associated with LOCO or POCO in patients with CAD after newer-generation DES implantation. Our findings suggest that NIRS-derived underlying lipid-rich plaque is not associated with the risk of stent-related events and patient-based outcomes in patients with CAD who have received newer-generation DESs.
富含脂质的斑块是引发未来冠状动脉事件的重要基质。然而,新一代药物洗脱支架(DES)植入后冠状动脉病变中潜在斑块特征的临床意义仍不明确。
本研究分析了REASSURE-NIRS多中心注册研究中416例冠心病(CAD)患者(慢性冠状动脉综合征/急性冠状动脉综合征=264/181)植入新一代DES后的445个靶病变。采用近红外光谱(NIRS)成像评估靶病变支架植入后的最大脂质核心负荷指数(残余最大脂质核心负荷指数)。主要和次要结局为3年病变导向临床结局(LOCO):心源性死亡、非致死性靶病变相关心肌梗死(MI)或缺血驱动的靶病变血运重建(ID-TLR),以及患者导向临床结局(POCO):全因死亡、非致死性MI或ID非计划血运重建。根据残余最大脂质核心负荷指数三分位数比较结局。
残余最大脂质核心负荷指数中位数为183;16%的病变残余最大脂质核心负荷指数>400。在观察期内,较高的残余最大脂质核心负荷指数与LOCO或POCO的发生可能性增加无关(LOCO,对数秩P=0.76;POCO,对数秩P=0.84)。混合效应逻辑回归表明,残余最大脂质核心负荷指数不能预测LOCO(比值比[OR],1.000;95%置信区间[CI],0.997-1.003;P=0.95)。残余最大脂质核心负荷指数与POCO之间无显著关系(OR,1.001;95%CI,0.999-1.002;P=0.30)。
新一代DES植入后CAD患者的残余最大脂质核心负荷指数与LOCO或POCO无关。我们的研究结果表明,NIRS检测到的潜在富含脂质斑块与接受新一代DES的CAD患者支架相关事件风险和基于患者的结局无关。