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.

中文翻译：

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富含脂质和非富含冠状动脉斑块支架置入术后 2 年的结果

背景尸检研究表明，在富含脂质的斑块 (LRP) 中植入支架可能与不良结果相关。目的 本研究的目的是评估近红外光谱 (NIRS) 检测到的 LRP 与采用现代药物洗脱支架治疗的冠状动脉疾病患者的临床结果之间的关联。方法 在这个前瞻性、多中心登记处，NIRS 对接受冠状动脉造影和可能的经皮冠状动脉介入治疗 (PCI) 的患者进行。脂质核心负荷指数 (LCBI) 计算为感兴趣区域内 LRP > 0.6 概率的像素分数。MaxLCBI4mm 定义为任何 4 毫米长段内的最大 LCBI。主要不良心脏事件 (MACE) 包括心源性死亡、心肌梗塞、明确或可能的支架内血栓形成，或进行性心绞痛或不稳定性心绞痛的计划外血运重建或再入院治疗。事件被细分为与罪魁祸首（治疗）病灶相关、非罪魁祸首（未治疗）病灶相关或不确定。结果 在参加 COLOR（天然冠状动脉感兴趣的脂质核心斑块的化学计量学观察）的 1,999 名患者中，有 1,621 名患者进行了 PCI，18.0% 的患者发生了 MACE，其中 8.3% 与罪犯病变相关2 年随访期间，10.7% 与非罪犯病变相关，3.1% 不确定。近 9 名患者 (0.45%) 发生近红外成像并发症，导致 1 例围手术期心肌梗死和 1 例急诊冠状动脉搭桥术。在 1,189 名患者中获得了 PCI 前 NIRS 成像，在调整临床和程序因素后，罪犯病变相关 MACE 的 2 年发生率与 maxLCBI4mm 无显着相关性（maxLCBI4mm 每 100 的风险比：1.06；95% 置信区间：0.96 至 1.17；p = 0.28）。结论 与现代药物洗脱支架 PCI 后，在 NIRS 定义的 LRP 中支架植入与围手术期或晚期不良后果的增加无关。