Author + information
- Received August 12, 2019
- Revision received December 24, 2019
- Accepted January 20, 2020
- Published online March 23, 2020.
- Myong Hwa Yamamoto, MDa,b,
- Akiko Maehara, MDa,b,∗ (, )@crfheart,
- Gregg W. Stone, MDa,b,
- Annapoorna S. Kini, MDc,
- Emmanouil S. Brilakis, MD, PhDd,e,
- David G. Rizik, MDf,
- Kendrick Shunk, MD, PhDg,h,
- Eric R. Powers, MDi,
- Jonathan M. Tobis, MDj,
- Brijeshwar S. Maini, MDk,l,
- Simon R. Dixon, MBChBm,
- James A. Goldstein, MDm,
- John L. Petersen II, MD, MHSn,
- Philippe Généreux, MDb,o,p,
- Priti R. Shah, MSq,
- Aaron Crowley, MAb,
- Stephen J. Nicholls, MBBS, PhDr,
- Gary S. Mintz, MDb,
- James E. Muller, MDs and
- Giora Weisz, MDb,t
- aDivision of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
- bClinical Trials Center, Cardiovascular Research Foundation, New York, New York
- cDivision of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
- dVeterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
- eMinneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
- fHonorHealth Scottsdale Shea Medical Center, Scottsdale, Arizona
- gSan Francisco Veterans Affairs Medical Center, San Francisco, California
- hUniversity of California, San Francisco, California
- iMedical University of South Carolina, Charleston, South Carolina
- jUniversity of California Los Angeles Medical Center, Los Angeles, California
- kTenet Healthcare Corporation, Delray Beach, Florida
- lFlorida Atlantic University, Boca Raton, Florida
- mBeaumont Hospital, Royal Oak, Michigan
- nSwedish Medical Center, Seattle, Washington
- oGagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
- pHôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- qInfraReDx, Burlington, Massachusetts
- rMonash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia
- sBrigham and Women’s Hospital, Boston, Massachusetts
- tMontefiore Medical Center, Bronx, New York
- ↵∗Address for correspondence:
Dr. Akiko Maehara, Columbia University Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, New York 10019.
Background Autopsy studies suggest that implanting stents in lipid-rich plaque (LRP) may be associated with adverse outcomes.
Objectives The purpose of this study was to evaluate the association between LRP detected by near-infrared spectroscopy (NIRS) and clinical outcomes in patients with coronary artery disease treated with contemporary drug-eluting stents.
Methods In this prospective, multicenter registry, NIRS was performed in patients undergoing coronary angiography and possible percutaneous coronary intervention (PCI). Lipid core burden index (LCBI) was calculated as the fraction of pixels with the probability of LRP >0.6 within a region of interest. MaxLCBI4mm was defined as the maximum LCBI within any 4-mm-long segment. Major adverse cardiac events (MACE) included cardiac death, myocardial infarction, definite or probable stent thrombosis, or unplanned revascularization or rehospitalization for progressive angina or unstable angina. Events were subcategorized as culprit (treated) lesion–related, nonculprit (untreated) lesion–related, or indeterminate.
Results Among 1,999 patients who were enrolled in the COLOR (Chemometric Observations of Lipid Core Plaques of Interest in Native Coronary Arteries Registry), PCI was performed in 1,621 patients and MACE occurred in 18.0% of patients, of which 8.3% were culprit lesion–related, 10.7% were nonculprit lesion–related, and 3.1% were indeterminate during 2-year follow-up. Complications from NIRS imaging occurred in 9 patients (0.45%), which resulted in 1 peri-procedural myocardial infarction and 1 emergent coronary bypass. Pre-PCI NIRS imaging was obtained in 1,189 patients, and the 2-year rate of culprit lesion–related MACE was not significantly associated with maxLCBI4mm (hazard ratio of maxLCBI4mm per 100: 1.06; 95% confidence interval: 0.96 to 1.17; p = 0.28) after adjusting clinical and procedural factors.
Conclusions Following PCI with contemporary drug-eluting stents, stent implantation in NIRS-defined LRPs was not associated with increased periprocedural or late adverse outcomes compared with those without significant lipid.
Dr. Maehara has received grant support from Abbott Vascular and Boston Scientific; and has served as a consultant for Conavi Medical Inc. Dr. Stone has served as a consultant to and has equity in SpectraWave. Dr. Brilakis has received consulting/speaker honoraria from Abbott Vascular, American Heart Association (Associate Editor for Circulation), Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, InfraRedx, Medtronic, and Teleflex; has received research support from Regeneron and Siemens; and is a shareholder of MHI Ventures. Dr. Shunk has served as a consultant for Terumo, TransAortic Medical, and PercAssist Inc.; has equity in TransAortic Medical and PercAssist; and has received institutional grant support from Svelte, Siemens, CardioVascular Systems Inc., and Sanofi. Dr. Maini has served on the Advisory Board, received Speakers Bureau honoraria, and has served as consultant for Abbott Vascular, Medtronic, Boston Scientific, and Siemens; and has equity in East End Medical. Dr. Petersen has served on the Speakers Bureau of CSI, Inc.; has received research grants from CSI, Inc., Bristol-Myers Squibb/Pfizer, and National Institutes of Health SBIR sub-award from Veravanti; has received educational grants from Abbott Vascular, Boston Scientific, Phillips, Bristol-Myers Squibb/Pfizer, Janssen, Novartis, and AstraZeneca; has served as a research investigator/clinical trial participant for Keystone Heart, CSI Inc., Abbott Vascular, Boston Scientific, Abiomed, Svelte Medical, Niech Medical, and Novartis; and has stock/ownership in Veravanti. Dr. Généreux has received speaker fees from Abbott Vascular, Edwards Lifesciences, Medtronic, Tryton Medical Inc., Cardinal Health, and Cardiovascular Systems Inc.; has received consulting fees from Abbott Vascular, Boston Scientific, Cardiovascular Systems Inc., and Pi-Cardia; has received institutional research grants from Boston Scientific; and has equity in SIG.NUM, SoundBite Medical Solutions Inc., Saranas, and Pi-Cardia. Dr. Shah is an employee of InfraReDx. Dr. Nicholls has received research support from AstraZeneca, Amgen, Eli Lilly, Novartis, Resverlogix, InfraReDx, Sanofi-Regeneron, and Cerenis; and has served as a consultant for AstraZeneca, Amgen, Boehringer Ingelheim, CSL Behring, Akcea, Cerenis, Eli Lilly, Kowa, Novartis, Merck, Pfizer, Takeda, and Sanofi-Regeneron. Dr. Mintz has received honoraria from Boston Scientific/Philips. Dr. Muller has served as a consultant for SpectraWAVE, Inc. Dr. Weisz has served as an Advisory Board member for Corindus, Filterlex, and TriSol; and has received institutional grant support from Abbott, Ancora, Corindus, CSI, Shock Wave, Svelte, and V-Wave. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Steven E. Nissen, MD, served as Guest Associate Editor for this paper.
- Received August 12, 2019.
- Revision received December 24, 2019.
- Accepted January 20, 2020.
- 2020 American College of Cardiology Foundation
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