Treatment effect of lipid-lowering strategy measured by intracoronary near-infrared spectroscopy (NIRS)-derived lipid core burden index (LCBI): A systematic review and meta-analysis.

AIM: To evaluate the effect of lipid-lowering therapies on the change of near-infrared spectroscopy (NIRS)-derived maximum lipid core burden index within a 4-mm segment (maxLCBI4mm).

METHODS

A systematic review and meta-analysis of studies comparing lipid-lowering therapies reporting baseline and follow-up NIRS-derived maxLCBI4mm in patients with coronary artery disease (CAD) was performed. Data were pooled by meta-analysis using a random-effects model. The prespecified primary endpoint was the reduction of maxLCBI4mm at follow-up. Subgroup analyses were performed according to follow-up duration and proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) use.

RESULTS

Seven studies, comprising a total of 920 lesions, were included. Overall, lipid-lowering therapy was not associated with a statistically significant reduction in maxLCBI4mm (SMD -0.18; 95% CI -0.42 to 0.07; p = 0.15, I2 = 60.5%). Subgroup analyses revealed no significant differences in terms of follow-up duration or PCSK9i use.

CONCLUSIONS

Lipid-lowering therapies were not associated with a statistically significant overall reduction in NIRS-derived maxLCBI4mm in this study-level meta-analysis. Although the direction of effect numerically favored more intensive lipid-lowering strategies, including PCSK9 inhibitor-based regimens, these findings remained non-significant and should be interpreted cautiously. Larger, methodologically rigorous studies are needed to determine whether specific therapies or patient subgroups derive measurable plaque lipid reduction on serial NIRS imaging and whether such imaging changes translate into improved clinical outcomes.