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TOPLINE
Patients with lipid-rich coronary plaques had a higher risk for cardiac events than those with non-lipid-rich plaques, and had a lower risk with the combination of preventive percutaneous coronary intervention (PCI) and optimal medical therapy than with optimal medical therapy alone.
METHODOLOGY
- A randomized, open-label trial (PREVENT) found that preventive PCI added to optimal medical therapy reduced coronary events in patients with non-flow-limiting vulnerable plaques. In this post hoc analysis, researchers examined whether the benefit of preventive PCI differed by the lipid content of the plaque.
- The analysis included 632 lesions from 598 adults enrolled in the trial between September 2015 and September 2021 at centers in South Korea, Taiwan, Japan, and New Zealand.
- All lesions had a plaque burden above 70% and a minimal lumen area below 4.0 mm2 on intravascular ultrasound. Patients were randomly assigned to receive either optimal medical therapy alone or preventive PCI in addition to optimal medical therapy.
- Lipid content was measured using a combined intravascular ultrasound and near-infrared spectroscopy catheter. Plaques with a maximum lipid core burden index above 315 in any 4-mm segment were classified as lipid-rich plaques.
- The primary outcome was a composite of death from cardiac reasons, ischemia-driven target vessel revascularization, target vessel myocardial infarction, or hospitalization for unstable or worsening angina.
TAKEAWAY
- Lipid-rich plaques were identified in 223 patients (37.3%; mean age, 64.9 years; 32.3% women).
- Over a median follow-up duration of 5.6 years, the events of the primary outcome were more common in patients with lipid-rich plaques than in those with non-lipid-rich plaques (12.5% vs 4.7%), corresponding to a 2.08-fold higher risk (P = .039).
- Among patients with lipid-rich plaques, those who received preventive PCI along with optimal medical therapy had a 77% lower risk for the primary composite outcome than those who received optimal medical therapy alone (P < .001).
- Patients with non-lipid-rich plaques did not benefit significantly from the addition of preventive PCI to optimal medical therapy. The treatment effect differed significantly between the two plaque types (P for interaction < .001).
IN PRACTICE
"[The] findings highlight the importance of the synergistic utility of characterizing plaque composition along with morphology in guiding preventive PCI decisions," the researchers wrote.
SOURCE
The study was led by Seong-Bong Wee, MD, of University of Ulsan College of Medicine in Seoul, South Korea. It was published online on October 6 in Circulation.
LIMITATIONS
The study was a post hoc analysis; thus, patients were not grouped by lipid burden when treatments were randomly assigned. The trial was open label, which may have led to more repeat procedures in patients who received optimal medical therapy alone. Most patients were East Asian men.
DISCLOSURES
No specific funding source was reported for the post hoc analysis. Several authors reported receiving research grants, speaker fees, or consulting payments from companies that make medical devices and drugs. A few authors also reported owning stock or equity in such companies, and some reported receiving institutional research funding. Detailed author disclosures are reported in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
