Predicting future left anterior descending artery events from non-culprit lesions: insights from the Lipid-Rich Plaque study.

The left anterior descending (LAD) artery is the most frequently affected site by coronary artery disease. The prospective Lipid Rich Plaque (LRP) study, which enrolled patients undergoing imaging of non-culprits followed over 2 years, reported the successful identification of coronary segments at risk of future events based on near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) lipid signals. We aimed to characterize the plaque events involving the LAD vs. non-LAD segments. LRP enrolled 1563 patients from 2014 to 2016. All adjudicated plaque events defined by the composite of cardiac death, cardiac arrest, non-fatal myocardial infarction, acute coronary syndrome, revascularization by coronary bypass or percutaneous coronary intervention, and rehospitalization for angina with >20% stenosis progression and reported as non-culprit lesion-related major adverse cardiac events (NC-MACE) were classified by NIRS-IVUS maxLCBI4 mm (maximum 4-mm Lipid Core Burden Index) ≤400 or >400 and association with high-risk-plaque characteristics, plaque burden ≥70%, and minimum lumen area (MLA) ≤4 mm2. Fifty-seven events were recorded with more lipid-rich plaques in the LAD vs. left circumflex and right coronary artery; 12.5% vs. 10.4% vs. 11.3%, P = 0.097. Unequivocally, a maxLCBI4 mm >400 in the LAD was more predictive of NC-MACE [hazard ratio (HR) 4.32, 95% confidence interval (CI) (1.93-9.69); P = 0.0004] vs. [HR 2.56, 95% CI (1.06-6.17); P = 0.0354] in non-LAD segments. MLA ≤4 mm2 within the maxLCBI4 mm was significantly higher in the LAD (34.1% vs. 25.9% vs. 13.7%, P < 0.001). Non-culprit lipid-rich segments in the LAD were more frequently associated with plaque-level events. LAD NIRS-IVUS screening may help identify patients requiring intensive surveillance and medical treatment.

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Déclaration de conflit d'intérêts

Conflict of interest: R.W., C.D.M., H.M.G.-G., and R.T. were Principal Investigator, European Principal Investigator, Responsible Officer Core Laboratory NIRS-IVUS and angiographic analysis, Worldwide Study Coordinator of the Lipid Rich Trial, sponsored by Infraredx-Nipro, Bedford, MA, USA. H.M.G.-G. reports the following institutional grant support: Biotronik, Boston Scientific, Medtronic, Abbott, Neovasc, Shockwave, Phillips, and Corflow. C.D.M. is the recipient of research grants (through the Department of Clinical and Experimental Medicine of the University of Florence) from AMGEN, Behring, Chiesi, Daiichi Sankyo, Edwards, Medtronic, and Shockwave. Z.A.A. reports grants from NIH/NHLBI, Abbott Vascular, and Cardiovascular Systems Inc.; personal fees from Amgen, Astra Zeneca, and Boston Scientific; and equity from Shockwave Medical. G.S.M. reports honoraria from Boston Scientific and Philips. R.W. reports serving on the advisory boards of Abbott Vascular, Amgen, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, and Pi-Cardia Ltd.; being a consultant for Abbott Vascular, Amgen, Biotronik, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd., and Transmural Systems; receiving grant support from AstraZeneca, Biotronik, Boston Scientific, and Chiesi; serving on the speakers bureaus of AstraZeneca and Chiesi, and being an investor in MedAlliance and Transmural Systems. All other authors declared no conflict of interest.