Lipid-rich plaques predict non-target-lesion ischemic events in patients undergoing percutaneous coronary intervention.
BACKGROUND
Despite growing interest in non-target lesion events in patients undergoing percutaneous coronary intervention (PCI), there has been little discussion of predictors.


RESULTS
A total of 155 consecutive patients who underwent PCI were enrolled. Conventional and integrated backscatter intravascular ultrasound (IB-IVUS) parameters were measured in non-target lesions utilizing a 40-MHz intravascular catheter. Lipid-rich plaques (LRP) were defined as lesions with an increased lipid volume (> median) and greater lipid content. Non-target ischemic events were defined as death, non-fatal myocardial infarction, any repeat revascularization and rehospitalization for angina involving the non-target vessel or the target vessel outside the index lesion. During the follow-up period (median: 1,265 days), non-target events were observed in 16 patients (11%). Using the Cox proportional hazard model, LRP (odds ratio [OR], 6.06; 95% confidence interval [CI]: 1.81-20.4, P = 0.0035), elevated serum C-reactive protein (CRP) levels (OR, 6.83; 95%CI: 2.19-21.3, P = 0.0009) and acute coronary syndrome present at baseline (OR, 4.08; 95%CI: 1.21-13.8, P = 0.024) were significantly and independently associated with non-target events. Synergistic effects of LRP and elevated serum CRP levels for prediction of non-target events (OR, 14.8; 95%CI: 4.57-48.0, P < 0.0001) were found even after adjusting for confounders.


CONCLUSIONS
LRP measured using IB-IVUS proved to be an independent morphologic predictor of non-target ischemic events after PCI, particularly enhancing the risk in patients with elevated serum CRP levels.
Department of Cardiology, Chubu-Rosai Hospital, Nagoya, Japan. amanot@med.nagoya-u.ac.jp
Tetsuya
T
Amano
Tatsuaki
T
Matsubara
Tadayuki
T
Uetani
Masataka
M
Kato
Bunichi
B
Kato
Tomohiro
T
Yoshida
Ken
K
Harada
Soichiro
S
Kumagai
Ayako
A
Kunimura
Yusaku
Y
Shinbo
Hideki
H
Ishii
Toyoaki
T
Murohara
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008055:Lipids / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology* / Q000401:mortality; D015588:Observer Variation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D015854:Up-Regulation
D015415:Biomarkers; D008055:Lipids; D002097:C-Reactive Protein