Preventive PCI was associated with a substantially lower risk of major cardiac events in patients with near-infrared spectroscopy–defined lipid-rich plaques (LRPs), but not in those without LRPs, suggesting that plaque composition may be more informative than plaque size alone in selecting lesions for preventive treatment. In this post hoc analysis of 598 patients from the PREVENT trial with 632 non–flow-limiting lesions characterized by intravascular ultrasound and near-infrared spectroscopy, LRPs—defined as a maximum lipid core burden index over 4 mm >315—were identified in 37.3% of patients. Over a median 5.6-year follow-up, the primary composite outcome of cardiac death, target-vessel myocardial infarction, ischemia-driven target-vessel revascularization, or hospitalization for unstable/progressive angina occurred more frequently in patients with LRPs than in those without LRPs (12.5% vs. 4.7%). Among patients with LRPs, preventive PCI significantly reduced the primary outcome compared with optimal medical therapy alone (7.3% vs. 17.6%; adjusted HR, 0.23), whereas no benefit was observed in patients without LRPs (5.5% vs. 4.2%; adjusted HR, 1.00). These findings suggest that identifying vulnerable plaque by its lipid composition, rather than relying solely on morphological severity such as plaque burden or lumen area, may help guide preventive PCI. Source: https://www.ahajournals.org/
