Long-term prognostic value of residual lipid burden in acute myocardial infarction.

BACKGROUND AND AIMS: To examine the clinical significance and prognostic value of total coronary artery non-culprit residual lipid burden (RLB) after percutaneous coronary intervention in acute myocardial infarction (AMI) patients.

METHODS

A total of 1312 AMI patients who underwent three-vessel optical coherence tomography (OCT) were divided into low RLB group (n = 656) and high RLB group (n = 656) based on median value of OCT-derived RLB (total lipid index of all non-culprit lesions). Patients were followed for up to 5 years (median 4.1 years). Major adverse cardiovascular events (MACE) were recorded.

RESULTS

The high RLB group had more frequent multi-vessel disease, non-culprit plaque rupture, thin-cap fibroatheroma (TCFA: 53.8% vs. 11.0%), and other vulnerable plaque features (all p < 0.001) than the low RLB group. After adjusting for clinical risk factors, a high RLB independently predicted non-culprit plaque rupture, TCFA, and vulnerable plaque features. Patients with a high RLB had a significantly greater incidence of 5-year non-culprit lesion-related MACE (8.4% vs. 2.6%, adjusted HR: 3.84, 95%CI: 1.98-7.45) than patients with a low RLB; most events were ischemia-driven revascularization. When a high RLB and non-culprit TCFA were simultaneously added to the model, a high RLB remained predictive (p = 0.002), but non-culprit TCFA was no longer predictive (p = 0.079). When used as a continuous variable, the prognostic value of RLB was attenuated (AUC = 0.63). Moreover, the association of RLB with plaque vulnerability and outcomes was observed in both sexes.

CONCLUSIONS

OCT-derived RLB was associated with pancoronary plaque characteristics in AMI patients. A high RLB predicted 5-year adverse events independent of TCFA.