Prognostic impact of lipid contents on the target lesion in patients with drug eluting stent implantation

Abstract

Background: Regardless of the imaging modality, lipid-rich coronary plaques have been associated with adverse prognostic factors, but there have been few studies on the relationship between long-term adverse outcome and target lesion morphology. Purpose: We sought to determine the morphologic predictors of Major Adverse Cardiac Events (MACEs) after successful Percutaneous Coronary Intervention (PCI) with Drug Eluting Stents (DES), using Integrated Backscatter Intravascular Ultrasound (IB-IVUS). Methods: Conventional and IB-IVUS were performed in 260 consecutive patients who underwent PCI with DES. Three-dimensional analyses were performed to determine plaque volume and the volume of each plaque component (lipid, fibrous, and calcification). Patients were divided into 2 groups according to the median Lipid Volume (LV) in the target lesion. Results: MACEs were defined as death, nonfatal myocardial infarction, and any repeat revascularization. The median follow-up interval was 1285 days. MACEs were observed in 64 patients (24.6%). Patients having a larger LV compared to their counterparts had worse long-term clinical outcomes regarding mortality (3.8% vs. 0%, p=0.02) and MACEs (31.5% vs. 17.7%, p=0.008) by log-rank test. After adjustment for confounders, diabetes (Odds Ratio (OR), 1.69; 95% CI 1.01-2.82, p=0.04) was significantly and independently associated with MACEs. In order to additional consideration about target lesion plaque morphology, large LV (OR, 1.95; 95% CI 1.14-3.33, p=0.02) was significantly and independently associated with MACEs. Conclusion: The assessment of coronary plaque characteristics in the target lesion may be useful to predict long-term outcome following successful coronary intervention.