Additive Effect of Multiple High-Risk Coronary Artery Segments on Patient Outcomes: LRP Study Sub-Analysis.

BACKGROUND

The Lipid Rich Plaque (LRP) Study established the association between high volume of lipidic content (maximum Lipid Core Burden Index [maxLCBI] >400) in the coronary arteries and subsequent non-culprit major adverse cardiac events (NC-MACE). This analysis sought to assess the clinical impact of more than one lipid-rich plaque in the coronary tree.

METHODS

The LRP patient population was divided into four cohorts: 1) patients with all segments with maxLCBI = 0; 2) patients with all coronary segments maxLCBI < 400, but >0; 3) patients with 1 segment maxLCBI > 400; and 4) patients with 2+ coronary segments with maxLCBI > 400. Baseline characteristics, plaque-level characteristics, and follow-up outcomes were described.

RESULTS

Among 1550 patients, only 3.2 % had all segments with maxLCBI = 0; 65.1 % had segments with maxLCBI > 0 but <400; 22.5 % had one segment with maxLCBI > 400; and 9.5 % had 2+ coronary segments with maxLCBI > 400. Distribution within the coronary tree (one versus multiple arteries) did not differ. Overall, 1269 patients were allocated to follow-up (per study design). The composite of all-cause death, cardiac death, any revascularization, and NC-MACE was statistically higher in patients with 1 segment maxLCBI > 400 and numerically even higher in patients with 2+ segments with maxLCBI > 400. Patients with maxLCBI = 0 had no events within two years.

CONCLUSION

There is a stepwise increased risk of all-cause death, cardiac death, any revascularization, and NC-MACE according to the number of coronary segments with maxLCBI > 400. In contrast, maxLCBI = 0 results in a low event rate.

CLINICAL TRIAL REGISTRATION

The Lipid-Rich Plaque Study (LRP), https://clinicaltrials.gov/ct2/show/NCT02033694, NCT02033694.