Additive Effect of Multiple High-Risk Coronary Artery Segments on Patient Outcomes: LRP Study Sub-Analysis.

Background: The Lipid Rich Plaque (LRP) Study established the association between high volume of lipidic content (maximum Lipid Core Burden Index [maxLCBI _4mm ] >400) in the coronary arteries and subsequent non-culprit major adverse cardiac events (NC-MACE). This analysis sought to assess the clinical impact of more than one lipid-rich plaque in the coronary tree.
Methods: The LRP patient population was divided into four cohorts: 1) patients with all segments with maxLCBI _4mm = 0; 2) patients with all coronary segments maxLCBI _4mm < 400, but >0; 3) patients with 1 segment maxLCBI _4mm > 400; and 4) patients with 2+ coronary segments with maxLCBI _4mm > 400. Baseline characteristics, plaque-level characteristics, and follow-up outcomes were described.
Results: Among 1550 patients, only 3.2 % had all segments with maxLCBI _4mm = 0; 65.1 % had segments with maxLCBI _4mm > 0 but <400; 22.5 % had one segment with maxLCBI _4mm > 400; and 9.5 % had 2+ coronary segments with maxLCBI _4mm > 400. Distribution within the coronary tree (one versus multiple arteries) did not differ. Overall, 1269 patients were allocated to follow-up (per study design). The composite of all-cause death, cardiac death, any revascularization, and NC-MACE was statistically higher in patients with 1 segment maxLCBI _4mm > 400 and numerically even higher in patients with 2+ segments with maxLCBI _4mm > 400. Patients with maxLCBI _4mm = 0 had no events within two years.
Conclusion: There is a stepwise increased risk of all-cause death, cardiac death, any revascularization, and NC-MACE according to the number of coronary segments with maxLCBI _4mm > 400. In contrast, maxLCBI _4mm = 0 results in a low event rate.
Clinical Trial Registration: The Lipid-Rich Plaque Study (LRP), https://clinicaltrials.gov/ct2/show/NCT02033694, NCT02033694.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ron Waksman, Carlo Di Mario, Hector Garcia-Garcia, and Rebecca Torguson were Principal Investigator, European Principal Investigator, Responsible Officer Core Laboratory NIRS-IVUS and angiographic analysis, and Worldwide Study Coordinator, respectively, of the Lipid Rich Plaque Study, sponsored by Infraredx-Nipro, Burlington, MA, USA. Carlo Di Mario is the recipient of research grants (through the Department of Clinical & Experimental Medicine of the University of Florence) from Amgen, Behring, Chiesi, Daiichi-Sankyo, Edwards, Medtronic, and Shockwave. Hector Garcia-Garcia reports the following institutional grant support: Biotronik, Boston Scientific, Medtronic, Abbott, Neovasc, Shockwave, Philips, and CorFlow. Gary Mintz reports honoraria from Boston Scientific and Abiomed. Ron Waksman reports serving on the advisory boards of Abbott Vascular, Boston Scientific, Medtronic, Philips IGT, and Pi-Cardia Ltd.; being a consultant for Abbott Vascular, Biotronik, Boston Scientific, Cordis, Medtronic, Philips IGT, Pi-Cardia Ltd., Swiss Interventional Systems/SIS Medical AG, Transmural Systems Inc., and Venous MedTech; receiving grant support from AstraZeneca, Biotronik, Boston Scientific, Chiesi, Medtronic, and Philips IGT; serving on the speakers bureau of AstraZeneca; and being an investor in MedAlliance and Transmural Systems Inc. All other authors report no conflicts of interest.
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