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Long-term prognostic value of residual lipid burden in acute myocardial infarction
Chao Fang1, Lina Cui1, Jiawei Zhao1
1Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China; State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
Insights
High residual lipid burden (RLB) in non-culprit coronary arteries after PCI in acute myocardial infarction (AMI) patients predicts future cardiovascular events, independent of plaque vulnerability. This finding highlights RLB as a key prognostic marker for AMI patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomarkers
Background:
- Percutaneous coronary intervention (PCI) is standard for acute myocardial infarction (AMI).
- Non-culprit lesions in AMI patients can contribute to adverse outcomes.
- Residual lipid burden (RLB) in non-culprit arteries may indicate ongoing plaque vulnerability.
Purpose of the Study:
- To assess the clinical significance of total coronary artery non-culprit residual lipid burden (RLB).
- To determine the prognostic value of RLB after PCI in AMI patients.
- To investigate the association of RLB with plaque characteristics and major adverse cardiovascular events (MACE).
Main Methods:
- 1312 AMI patients underwent three-vessel optical coherence tomography (OCT).
- Patients were stratified into low and high RLB groups based on median OCT-derived RLB.
- Follow-up for up to 5 years to record MACE.
Main Results:
- High RLB was associated with more multi-vessel disease, non-culprit plaque rupture, and thin-cap fibroatheroma (TCFA).
- High RLB independently predicted non-culprit plaque rupture and TCFA.
- High RLB was linked to a significantly higher incidence of 5-year non-culprit lesion-related MACE (8.4% vs. 2.6%).
- RLB remained a significant predictor of adverse events even when TCFA was considered.
Conclusions:
- OCT-derived RLB is associated with pancoronary plaque characteristics in AMI patients.
- Elevated RLB is an independent predictor of 5-year adverse cardiovascular events in AMI patients.
- RLB provides prognostic information beyond traditional markers like TCFA.
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.
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