Impact of Post-PCI Lipid Core Burden Index on Angiographic and Clinical Outcomes: Insights From NIRS-IVUS

BACKGROUND: The impact of lipid core burden index (LCBI) after percutaneous coronary intervention (PCI) in the stented segment assessed by intracoronary near-infrared spectroscopy on the outcomes remains unclear. METHODS: In this prospective observational study, we aimed to assess the impact of post-PCI LCBI on late luminal loss and clinical outcomes. Post-PCI intracoronary near-infrared spectroscopy imaging was performed in the stented segment after PCI. Patients were categorized into 2 groups based on the post-PCI max LCBI 4mm with a cut-off value of 200. Angiographic and clinical outcomes were compared at 12 months. The primary end point was angiographic late luminal loss. The secondary end point was target lesion failure (composite of cardiovascular death, target vessel myocardial infarction, and clinically driven target lesion revascularization) and major adverse cardiac and cerebrovascular events (composite of cardiac death, myocardial infarction, any repeat revascularization, and stroke). RESULTS: A total of 228 patients with 278 target lesions were followed up for 1 year. One-year follow-up angiography was performed on 198 lesions in 163 patients. Follow-up quantitative coronary angiography revealed that stented segments with post-PCI max LCBI 4mm ≥200 had higher late luminal loss compared with those with a post-PCI max LCBI 4mm <200 (mean, 0.503±0.683 mm versus 0.115±0.326 mm; P <0.001; median, 0.250 mm versus 0.050 mm; P <0.001). Patients with post-PCI max LCBI 4mm ≥200 had a significantly higher 1-year cumulative incidence of both target lesion failure (6.9% versus 0.6%; P =0.002) and major adverse cardiac and cerebrovascular events (15.1% versus 2.2%; P <0.001). CONCLUSIONS: Post-PCI LCBI assessed by intracoronary near-infrared spectroscopy-intravascular ultrasound was associated with late luminal loss as well as subsequent target lesion failure and major adverse cardiac and cerebrovascular events.