European heart journal. Cardiovascular Imaging · 2026
Achieved LDL-C levels <55 mg/dL and cardiac events in patients and lesions harbouring lipid-rich plaque phenotypes.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Kataoka Yu, Nicholls Stephen J, Kiyoshige Eri, Nishimura Kunihiro, Puri Rishi, Kitahara Satoshi, Murai Kota, Mitsui Kentaro, Tomishima Yoshiyuki, Sawada Kenichiro, Matama Hideo, Iwai Takamasa, Honda Satoshi, Nakao Kazuhiro, Fujino Masashi, Takagi Kensuke, Yoneda Shuichi, Otsuka Fumiyuki, Nishihira Kensaku, Takamisawa Itaru, Asaumi Yasuhide, Noguchi Teruo
Аннотация
AIMS: The European Society of Cardiology guidelines recommend low-density lipoprotein cholesterol (LDL-C) < 55 mg/dL in very-high-risk patients. Given that plaque phenotype underscores its modulatory response to lipid-lowering therapies, patients and lesions harbouring lipid-laden plaques may benefit from LDL-C < 55 mg/dL to reduce their cardiovascular risks.
METHODS AND RESULTS: The REASSURE-NIRS (REvelation of PAthophySiological PhenotypeS of VUlneRable Lipid-Rich PlaquE on Near-InfraRed Spectroscopy) multi-centre registry enrolled 853 coronary artery disease patients (non-culprit lesions = 1662) receiving NIRS/IVUS-guided PCI (NCT04864171). LDL-C level at 3 months after PCI was used as on-treatment LDL-C. Study subjects were stratified according to maxLCBI4mm at non-culprit lesions < vs. ≥324.7. In each group, major adverse cardiac events (MACE) (=cardiac-cause death + non-fatal myocardial infarction (MI) + ischaemia-driven non-culprit lesion revascularization) was compared in those with on-treatment LDL-C < vs. ≥55 mg/dL. 31.6% of study subjects achieved on-treatment LDL-C < 55 mg/dL. During the observational period (median = 1109 days), MACE rate did not differ in patients with maxLCBI4mm < 324.7 exhibiting on-treatment LDL-C levels < and ≥55 mg/dL [adjusted hazard ratio (HR) = 1.42, 95% confidence interval (CI) = 0.80-2.54, P = 0.227]. By contrast, in patients with non-culprit lesion maxLCBI4mm ≥ 324.7, a significantly reduced MACE rate was observed in those with on-treatment LDL-C < 55 mg/dL (adjusted HR = 0.23, 95% CI: 0.09-0.57, P = 0.010). These relationships were similarly observed in a lesion-based analysis (non-culprit lesion maxLCBI4mm < 324.7: adjusted HR = 1.30, 95% CI = 0.42-4.00, P = 0.640, non-culprit lesion maxLCBI4mm ≥ 324.7: adjusted HR = 0.27, 95% CI:0.08-0.97, P = 0.045). Notably, in patients with multiple non-culprit lesions with maxLCBI4mm ≥ 324.7, on-treatment LDL-C < 55 mg/dL was associated with a lower frequency of MACE (adjusted HR = 0.22, 95% CI = 0.09-0.53, P < 0.001), whereas this relationship was not observed in those with single non-culprit lesion with maxLCBI4mm ≥ 324.7 (adjusted HR = 0.03, 95% CI = 0.00-5.55, P = 0.196).
CONCLUSION: NIRS-derived lipid-rich plaque may be a potential imaging measure reflecting patients and lesions that may benefit from achieving LDL-C levels < 55 mg/dL.
METHODS AND RESULTS: The REASSURE-NIRS (REvelation of PAthophySiological PhenotypeS of VUlneRable Lipid-Rich PlaquE on Near-InfraRed Spectroscopy) multi-centre registry enrolled 853 coronary artery disease patients (non-culprit lesions = 1662) receiving NIRS/IVUS-guided PCI (NCT04864171). LDL-C level at 3 months after PCI was used as on-treatment LDL-C. Study subjects were stratified according to maxLCBI4mm at non-culprit lesions < vs. ≥324.7. In each group, major adverse cardiac events (MACE) (=cardiac-cause death + non-fatal myocardial infarction (MI) + ischaemia-driven non-culprit lesion revascularization) was compared in those with on-treatment LDL-C < vs. ≥55 mg/dL. 31.6% of study subjects achieved on-treatment LDL-C < 55 mg/dL. During the observational period (median = 1109 days), MACE rate did not differ in patients with maxLCBI4mm < 324.7 exhibiting on-treatment LDL-C levels < and ≥55 mg/dL [adjusted hazard ratio (HR) = 1.42, 95% confidence interval (CI) = 0.80-2.54, P = 0.227]. By contrast, in patients with non-culprit lesion maxLCBI4mm ≥ 324.7, a significantly reduced MACE rate was observed in those with on-treatment LDL-C < 55 mg/dL (adjusted HR = 0.23, 95% CI: 0.09-0.57, P = 0.010). These relationships were similarly observed in a lesion-based analysis (non-culprit lesion maxLCBI4mm < 324.7: adjusted HR = 1.30, 95% CI = 0.42-4.00, P = 0.640, non-culprit lesion maxLCBI4mm ≥ 324.7: adjusted HR = 0.27, 95% CI:0.08-0.97, P = 0.045). Notably, in patients with multiple non-culprit lesions with maxLCBI4mm ≥ 324.7, on-treatment LDL-C < 55 mg/dL was associated with a lower frequency of MACE (adjusted HR = 0.22, 95% CI = 0.09-0.53, P < 0.001), whereas this relationship was not observed in those with single non-culprit lesion with maxLCBI4mm ≥ 324.7 (adjusted HR = 0.03, 95% CI = 0.00-5.55, P = 0.196).
CONCLUSION: NIRS-derived lipid-rich plaque may be a potential imaging measure reflecting patients and lesions that may benefit from achieving LDL-C levels < 55 mg/dL.