Background: Vulnerable coronary plaques, particularly those rich in lipid content, are key contributors to the onset of acute coronary syndromes. The Lipid Core Burden Index (LCBI) has gained attention as a promising imaging biomarker for detecting patients who may be at increased risk of experiencing future major adverse cardiovascular events (MACE). Near-infrared spectroscopy (NIRS) is a novel imaging technique that detects plaques with high lipid content, which is a critical indicator of plaque vulnerability. This study evaluates the prognostic utility of NIRS-derived LCBI in predicting MACE in patients undergoing coronary angiography.

Methods:We conducted a prospective study involving 100 patients undergoing NIRS-IVUS imaging during clinically indicated coronary catheterization. The primary endpoint was a composite of MACE (defined as cardiac death, myocardial infarction, or unplanned revascularization) at 12 months. Non-culprit lesions were imaged using Makoto NIRS-IVUS, and the highest LCBI was recorded for each patient. Patients were stratified into two groups based on LCBI values: high-risk (≥400) and low-risk (<400). Event rates were compared using Kaplan-Meier analysis, and Cox proportional hazards modeling was used to assess the independent predictive value of LCBI.

Results:Among 100 patients (mean age 64±9 years; 72% male), 23 % had a non-culprit lesion with LCBI ≥400. At 12 month follow-up, the incidence of MACE was significantly higher in the high-LCBI group compared to the low-LCBI group (11.2% vs. 4.2%, p<0.001). After adjusting for traditional risk factors and angiographic stenosis severity, LCBI ≥400 remained an independent predictor of MACE (adjusted HR 3.6; 95% CI 2.1–6.2; p<0.001). Notably, most events occurred at sites with <70% angiographic stenosis, highlighting the added value of plaque characterization beyond lumen assessment.

Conclusion:NIRS-derived LCBI is a robust and independent predictor of future MACE in patients undergoing coronary angiography. An LCBI threshold of ≥400 identifies high-risk plaques in non-culprit segments, often missed by angiography alone. Incorporating NIRS imaging into routine clinical practice may enhance risk stratification and guide targeted preventive therapies in patients with coronary artery disease.

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