Lipid Burden and Efficacy of Preventive PCI of Vulnerable Atherosclerotic Coronary Plaques: Post Hoc Analysis From the PREVENT Trial.

Preventive PCI significantly reduces cardiac events in patients with lipid-rich plaques, with a 77% risk reduction compared to medical therapy alone in the PREVENT trial.

• Why it matters: Identifying which high-risk plaques benefit most from preventive intervention remains challenging, emphasizing the need for better risk stratification tools beyond traditional imaging.
• What they did: Researchers analyzed 598 patients with vulnerable plaques using near-infrared spectroscopy-derived lipid core burden index, comparing outcomes of preventive PCI versus medical therapy over a median of 5.6 years.
• The result: Preventive PCI lowered primary outcome risk in patients with lipid-rich plaques (7.3% vs. 17.6%), highlighting the importance of plaque composition in guiding treatment decisions, while no benefit was seen in non-lipid-rich plaques.