Coronary disease & ACSSecondary analysis
Lipid Burden and Efficacy of Preventive Percutaneous Coronary Intervention (PCI) of Vulnerable Atherosclerotic Coronary Plaques: Post Hoc Analysis From the PREVENT Trial
- Secondary analysis of the PREVENT randomised trial
- post hoc analysis
- multicenter
- open-label
Authors' conclusion
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.
Study context
- Population
- Patients with non-flow-limiting lesions (FFR >0.80), plaque burden >70% and MLA <4 mm² by IVUS, with NIRS evaluation performed
- Participants
- 598 patients · 632 lesions
- Comparison
- Preventive PCI vs optimal medical therapy alone
- Primary endpoint
- Composite of:
- Death from cardiac causes
- Target-vessel MI
- Ischemia-driven target-vessel revascularization
- Hospitalization for unstable or progressive angina
- Follow-up
- Median 5.6 years
Primary result
As reported in the abstract
Primary composite outcome, by LRP status
Preventive PCI vs OMT aloneAdjusted hazard ratio (95% CI)P value
LRP group (7.3% vs. 17.6%)
0.23(0.13–0.41)
P < 0.001non-LRP group (5.5% versus 4.2%)
1.00(0.54–1.86)
P = 0.97Further findings
| Outcome | LRP | Non-LRP | unadjusted HR (95% CI) | P value | |
|---|---|---|---|---|---|
| Primary composite outcome, LRP vs non-LRP (overall population) · median follow-up of 5.6 years | 12.5% | 4.7% | 2.08 (1.03–4.19) | P = 0.039 | |
| 0.20.5125Unadjusted hazard ratio (log scale) |
- Primary composite outcome, lipid-rich plaque (LRP) vs non-LRP (overall population): LRP present in 223 patients (37.3%) with 234 lesions
Original publication
Lipid Burden and Efficacy of Preventive PCI of Vulnerable Atherosclerotic Coronary Plaques: Post Hoc Analysis From the PREVENT Trial. Circulation. Published 6 October 2026. doi:10.1161/circulationaha.126.080384
Summarised from the published abstract; every number is checked against it