What does this research mean for the field?

High residual lipid burden (RLB) independently predicted a 5-year incidence of non-culprit lesion-related major adverse cardiovascular events (MACE) of 8.4% compared to 2.6% in the low RLB group (HR 3.84). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This study examines the prognostic value of residual lipid burden after percutaneous coronary intervention in acute myocardial infarction patients.

February 8, 2026

Long-term prognostic value of residual lipid burden in acute myocardial infarction: a three-vessel optical coherence tomography study

Key Result

High residual lipid burden after PCI in AMI patients predicts a 3.84-fold higher 5-year risk of non-culprit lesion-related MACE (8.4% vs 2.6%, P<0.001).

Key Points

This study examines the prognostic value of residual lipid burden after percutaneous coronary intervention in acute myocardial infarction patients.
Analyzed data from 1312 acute myocardial infarction patients undergoing three-vessel OCT imaging after PCI.
Divided patients into low and high residual lipid burden groups based on the median value from OCT-derived measurements.
Followed patients for up to 5 years to record major adverse cardiovascular events.
High residual lipid burden group had more frequent multi-vessel disease and non-culprit plaque rupture.
High residual lipid burden independently predicted non-culprit plaque rupture and vulnerable plaque features.
Patients with high residual lipid burden had a significantly greater incidence of 5-year adverse events (8.4% vs. 2.6%), particularly ischemia-driven revascularization.

Structured PICO

Does high residual lipid burden on OCT predict 5-year non-culprit lesion-related MACE in patients with AMI after successful PCI?

Population

1,312 patients with acute myocardial infarction (AMI) who underwent three-vessel optical coherence tomography (OCT) imaging after successful percutaneous coronary intervention (PCI), average age 57.0 years, 74.9% male.

Intervention

High residual lipid burden (RLB) derived from OCT (total lipid index of all non-culprit lesions above median)

Comparator

Low residual lipid burden (RLB) derived from OCT (below median)

Outcome

5-year non-culprit lesion-related major adverse cardiovascular events (MACE)composite

High residual lipid burden assessed by three-vessel OCT after successful PCI in AMI patients is a strong, independent predictor of 5-year non-culprit lesion-related MACE.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Coronary artery lipid accumulation is indicative of atherosclerosis. Purpose This study aimed to examine the clinical significance and prognostic value of residual lipid burden (RLB) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods Between January 2017 and December 2021, 1312 patients with AMI who underwent three-vessel optical coherence tomography (OCT) imaging after successful PCI were divided into low RLB group (n=656) and high RLB group (n=656) based on the median value of OCT-derived RLB (total lipid index of all non-culprit lesions). Patients were followed for up to 5 years. Major adverse cardiovascular events (MACE) were recorded. Results The average age was 57.0 years, and 74.9% were male. The high RLB group had more frequent multi-vessel disease (54.6% vs. 24.5%, P0.001), non-culprit plaque rupture (28.4% vs. 6.1%, P0.001), thin-cap fibroatheroma (TCFA: 53.8% vs. 11.0%, P0.001), and other vulnerable plaque features (all P0.001) compared to 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 hazard ratio HR: 3.84, 95% confidence interval CI: 1.98-7.45, P0.001) than patients with a low RLB; and most events were ischemia-driven revascularization (6.5% vs. 1.9%, P0.001). Moreover, the predictive value of a high RLB was independent of non-culprit TCFA. Conclusions OCT-derived RLB was strongly associated with pancoronary plaque characteristics in AMI patients. A high RLB was predictive of 5-year adverse events independent of TCFA.

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