In very high-risk patients with LDL-C ≥55 mg/dL, maxLCBI4mm >400 predicted higher NC-MACE incidence over 2 years (log-rank p < 0.001), unlike LDL-C <55 mg/dL.
Does lipid-rich plaque burden (maxLCBI4mm >400) predict non-culprit major adverse cardiac events in very high-risk patients stratified by LDL-C levels?
Lipid-rich plaque burden assessed by NIRS-IVUS predicts residual cardiovascular risk in very high-risk patients with LDL-C ≥55 mg/dL, highlighting the importance of plaque composition beyond LDL-C alone.
Absolute Event Rate: 0% vs 0%
Abstract Background The European Society of Cardiology recommends an LDL-C threshold of 55 mg/dL for very high-risk patients. Lipid Core Burden Index (LCBI) per 4-mm coronary segment (maxLCBI4mm 400), assessed by near-infrared spectroscopy (NIRS)-intravascular ultrasound, predicts non-culprit major adverse cardiac events (NC-MACE). Investigating the association of LDL-C thresholds and NC-MACE in LCBI groups is warranted. Purpose To evaluate the association between LDL-C very-high-risk threshold groups and NC-MACE, while investigating whether lipid-rich plaque burden measured by maxLCBI4mm further stratifies risk in very high-risk patients. Methods We analyzed data from an international multicenter prospective cohort (LRP Study, 2014-2016). Patients were stratified into high (maxLCBI4mm 400) and low (≤400) LCBI groups. LDL-C was calculated using the NIH equation. Spearman correlation assessed the relationship between maxLCBI4mm and LDL-C. NC-MACE, a composite of nonfatal myocardial infarction, acute coronary syndrome, revascularization, and angina-related hospitalization, was compared between LDL-C groups (≥55 mg/dL vs. 55 mg/dL) using Kaplan–Meier analysis with log-rank tests. Results 619 patients had baseline LCBI measurements and lipid panel data. The correlation between maxLCBI4mm and LDL-C was weakly positive (r = 0.063, p = 0.08). Among these patients, 523 had LDL-C levels ≥55 mg/dL, while 96 had LDL-C 55 mg/dL. Over a median follow-up of 2 years, the cumulative incidence of NC-MACE was 11% (n=66). In patients with LDL-C ≥55 mg/dL, NC-MACE incidence was significantly higher in those with maxLCBI4mm 400 compared to ≤400 (log-rank p 0.001). In contrast, NC-MACE rates in patients with LDL-C 55 mg/dL were not significantly different by maxLCBI4mm groups. Conclusion Our findings indicate that lipid-rich plaque burden (maxLCBI4mm 400) predicts cardiovascular events even in patients with LDL-C ≥55 mg/Dl. These findings suggest that plaque composition, rather than LDL-C alone, plays a critical role in residual cardiovascular risk stratification. Integrating intracoronary imaging with lipid management strategies may enhance risk assessment and guide targeted therapeutic interventions across risk thresholds.Kaplan–Meier Curves
Kuku et al. (Sat,) reported a other. In very high-risk patients with LDL-C ≥55 mg/dL, maxLCBI4mm >400 predicted higher NC-MACE incidence over 2 years (log-rank p < 0.001), unlike LDL-C <55 mg/dL.