Target Lesion Lipid Content Detected By Near-Infrared Spectroscopy After Stenting And The Risk Of Subsequent Target Lesion Failure

Objective: After percutaneous coronary intervention (PCI), it is unknown whether retained lipid content in the stented segment increases the risk of target lesion failure (TLF). This study evaluated the association between retained lipid content in the stented segment detected by post-PCI intracoronary near-infrared spectroscopy and TLF. Approach and Results: After the performance of PCI, post-PCI near-infrared spectroscopy-intravascular ultrasound images were acquired and analyzed by an independent core laboratory for retained lipid content in the stented segment, quantified by the maximum lipid core burden index in 4 mm (maxLCBI(4mm)). The primary outcome was TLF during follow-up, defined as a composite of cardiovascular death, target vessel myocardial infarction, and clinically driven target lesion revascularization. Among 202 patients with 209 target lesions treated by PCI and followed for 3.5 +/- 1.4 years, baseline post-PCI near-infrared spectroscopy-intravascular ultrasound images revealed a significantly greater maxLCBI(4mm) in stented lesions with (297 [211, 401]) versus without (119 [9, 258]) TLF during follow-up (P=0.006). By multivariate logistic regression, maxLCBI(4mm) in the stented segment was independently associated with subsequent TLF (odds ratio, 1.6 [95% CI, 1.2-2.1] for every 100-unit increase, P=0.004). By receiver-operating characteristic analysis, the optimal residual maxLCBI(4mm) threshold in the stented segment for subsequent TLF was 200. Stented lesions with a residual maxLCBI(4mm) >200 had significantly greater TLF during follow-up than stented lesions with a maxLCBI(4mm) <= 200 (15.0% versus 3.1%, P=0.002). Conclusions: Retained lipid content detected by near-infrared spectroscopy in the stented segment after PCI was associated with an increased risk of subsequent TLF.