Lipid-Rich Plaque Study Presented for NIRS-IVUS to Detect Patients and Plaques Vulnerable to MACE
September 24, 2018—The Cardiovascular Research Foundation (CRF) announced that results from the Lipid-Rich Plaque (LRP) study were presented by Principal Investigator Ron Waksman, MD, at TCT 2018, the 30th annual Transcatheter Cardiovascular Therapeutics scientific symposium, which is sponsored by CRF and held September 21–25 in San Diego, California.
CRF advised that the LRP study, which was funded by Infraredx Nipro, demonstrated the correlation between the presence of non–flow-limiting, nonintervened upon lipid-rich plaques detected by near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) imaging and the development of a major adverse cardiac event (MACE) from a de novo culprit lesion at both the patient level (vulnerable patients) and segment level (vulnerable plaques) within 24 months after intravascular imaging.
As summarized in the press release, the study enrolled 1,563 patients with suspected coronary artery disease who underwent cardiac catheterization with percutaneous coronary intervention (PCI) for an index event at 44 sites in the United States and Europe from February 2014 to March 2016. Imaging by NIRS-IVUS was performed in two or more arteries and patient-level and plaque-level events were detected for 2 years. All patients with at least one maxLCBI4mm segment ≥ 250 and a randomly selected 50% of patients with all maxLCBI4mm segments < 250 were followed.
In the vulnerable patient–level analysis, the risk of experiencing a nonculprit MACE event within 24 months was 18% higher with each 100-unit increase in maxLCBI4mm. Patients with maxLCBI4mm ≥ 400 had a MACE rate of 12.6% compared with 6.3% for patients with maxLCBI4mm < 400.
In the vulnerable plaque–level analysis, the risk of experiencing an event in a coronary segment within 24 months was 45% higher with each 100-unit increase in maxLCBI4mm. Plaque with maxLCBI4mm ≥ 400 had a MACE rate of 3.7% compared to 0.8% for plaque with maxLCBI4mm < 400.
Dr. Waksman, who is Associate Director of the Division of Cardiology at MedStar Heart Institute in Washington, DC, commented in the CRF announcement, “Multivessel NIRS can be easily and safely performed to assess and identify vulnerable patients and vulnerable plaques. Intravascular NIRS imaging in mildly or nonobstructive coronary arteries can be used as a tool to identify both patients and nonculprit arteries at high risk for future events and should be considered for use in patients undergoing cardiac catheterization with possible PCI.”