This research is Trending!
October 6, 2026Circulation
Lipid Burden and Efficacy of Preventive PCI of Vulnerable Atherosclerotic Coronary Plaques: Post Hoc Analysis From the PREVENT Trial
Seong-Bong WeeJung‐Min AhnDo‐Yoon KangJu Hyeon KimJungbok LeeHan Su ParkSoo Yeon AnKyeong-Won SeoS LEEYoungkeun AhnWon‐Jang KimChang‐Wook NamJin‐Ok JeongIn‐Ho ChaeHiroki ShiomiHsien‐Li KaoJoo‐Yong HahnSung‐Ho HerBong‐Ki LeeTae Hoon AhnKiyuk ChangDavid SmythGary S. MintzGregg W. StoneDuk‐Woo ParkSeung-Jung Parkfor the PREVENT Investigators
Key result
Preventive PCI cuts major events ~77% vs. medical therapy alone in lipid-rich plaques.
- adjusted HR 0.23
- 95% CI 0.13-0.41
- P<0.001
- n=598
Why the study?
Identifying which non–flow-limiting high-risk plaques derive the greatest benefit from preventive PCI compared with optimal medical therapy remains challenging.
Does preventive PCI reduce the composite of cardiac death, target-vessel MI, target-vessel revascularization, or hospitalization for angina compared to optimal medical therapy in patients with non-flow-limiting but vulnerable atherosclerotic plaques based on lipid core burden?
Study Design
Type
RCT (n=598)
Blinding
Open-label
Multicenter
Yes
Structured PICO
Does preventive PCI reduce the composite of cardiac death, target-vessel MI, target-vessel revascularization, or hospitalization for angina compared to optimal medical therapy in patients with non-flow-limiting but vulnerable atherosclerotic plaques based on lipid core burden?
P
Population
598 patients with non-flow-limiting coronary lesions featuring >70% plaque burden and <4 mm2 minimal lumen area, evaluated by near-infrared spectroscopy, followed for a median of 5.6 years.
I
Intervention
Preventive percutaneous coronary intervention (PCI)
C
Comparator
Optimal medical therapy alone
O
Outcome
Composite of death from cardiac causes, target-vessel myocardial infarction, ischemia-driven target-vessel revascularization, or hospitalization for unstable or progressive anginacomposite
Main Result
Hazard Ratio: 0.23 (95% CI 0.13–0.41)
Absolute Event Rate: 7.3% vs 17.6%
p-value: p=<0.001
Preventive PCI significantly reduces major adverse cardiac events in non-flow-limiting vulnerable plaques, but this benefit appears restricted to lesions with a high near-infrared spectroscopy-derived lipid core burden.
Limitations
- post hoc analysis
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
CKChinmay KhandkarCardiology researcher, University of Sydney
“Subgroup analysis exploring MACE in patients with thin-capped fibroatheromas, thick-capped fibroatheromas, high lipid burden, or any combination of these, would probably show higher event rates.”
“We suggest that it is possible that some of the benefit in the percutaneous coronary intervention group was in fact due to the dual antiplatelet therapy rather than the percutaneous coronary intervention itself, even after randomised treatment assignment in a clinical trial.”
“The first and perhaps most important issue is the small number of events in the 2-year analysis. In a trial of more than 1600 patients, there were only 24 fewer (mostly nonfatal) primary outcome events in the PCI arm.”
Implication
Preventive PCI was associated with lower events only in NIRS-defined LRPs; extends PREVENT by supporting composition-guided lesion selection in trials.
Abstract
BACKGROUND: Preventive percutaneous coronary intervention (PCI) of non–flow-limiting lesions (fractional flow reserve >0.80) that are high-risk plaques has emerged as a potential strategy to reduce cardiac events. However, identifying which lesions derive the greatest benefit from preventive PCI compared with optimal medical therapy alone remains challenging. This post hoc analysis evaluates the role of the near-infrared spectroscopy–derived lipid core burden index in identifying high-risk plaques that may benefit from preventive PCI. METHODS: Among the 1606 patients enrolled in the PREVENT trial (Preventive Coronary Intervention on Stenosis with Functionally Insignificant Vulnerable Plaque) from September 2015 to September 2021, an investigator-initiated, multicenter, open-label, randomized controlled trial, this post hoc analysis included 598 patients (mean age, 64.1±8.8 years; 27.9% women) comprising 632 lesions with a plaque burden >70% and a minimal lumen area <4 mm 2 by intravascular ultrasound in whom near-infrared spectroscopy evaluation was also performed. Lipid-rich plaque (LRP) was prespecified as having a maximum lipid core burden index over a 4-mm segment >315. The primary outcome was a composite of death from cardiac causes, target-vessel myocardial infarction, ischemia-driven target-vessel revascularization, or hospitalization for unstable or progressive angina. RESULTS: LRPs were present in 223 patients (37.3%) with 234 lesions. During median follow-up of 5.6 years, primary outcome events occurred more frequently in patients with LRPs than in those with non-LRPs (12.5% versus 4.7%; unadjusted hazard ratio, 2.08; 95% CI, 1.03–4.19; P =0.039) in the overall population. Within the LRP group, preventive PCI was associated with a lower risk of the primary outcome compared with optimal medical therapy alone (7.3% vs. 17.6%; adjusted hazard ratio, 0.23; 95% CI, 0.13–0.41; P <0.001). Conversely, no benefit of preventive PCI was observed in the non-LRP group (5.5% versus 4.2%; adjusted hazard ratio, 1.00; 95% CI, 0.54–1.86; P =0.97). A significant interaction was found between treatment strategy and the presence of LRP ( P interaction <0.001). CONCLUSIONS: In this post hoc analysis of the PREVENT trial, preventive PCI was associated with a lower risk of the primary composite outcome in patients with near-infrared spectroscopy–defined LRPs, whereas no significant association was observed in those with non-LRPs despite their large plaque burden and small minimal lumen area. These findings suggest the importance of plaque composition, beyond morphological severity alone, in guiding preventive PCI. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02316886.
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Discussion
No takes yet. Share an insight, caveat, or question.
Cite This Study
Wee et al. (2026) conducted an RCT in Vulnerable atherosclerotic coronary plaques (n=598). Preventive percutaneous coronary intervention (PCI) vs. Optimal medical therapy alone was evaluated on Composite of death from cardiac causes, target-vessel myocardial infarction, ischemia-driven target-vessel revascularization, or hospitalization for unstable or progressive angina (adjusted HR 0.23, 95% CI 0.13-0.41, p=<0.001). In patients with lipid-rich plaques, preventive PCI significantly reduced the primary composite outcome compared to medical therapy alone (7.3% vs 17.6%; HR 0.23; 95% CI 0.13-0.41; P<0.001).