Confirmation of the Intracoronary Near-Infrared Spectroscopy Threshold of Lipid-Rich Plaques That Underlie ST-Segment-Elevation Myocardial Infarction.

Abstract

OBJECTIVE:

In a previous exploratory analysis, intracoronary near-infrared spectroscopy (NIRS) found the majority of culprit lesions in ST-segment-elevation myocardial infarction (STEMI) to contain a maximum lipid core burden index in 4 mm (maxLCBI4mm) of >400. This initial study was limited by a small sample size, enrollment at a single center, and post hoc selection of the maxLCBI4mm ≥400 threshold. This study was designed a priori to substantiate the ability of NIRS to discriminate STEMI culprit from nonculprit segments and to confirm the performance of the maxLCBI4mm ≥400 threshold.

APPROACH AND RESULTS:

At 2 centers in the United States and Sweden, 75 STEMI patients underwent intracoronary NIRS imaging after establishing thrombolysis in myocardial infarction 3 flow, but before stenting. Blinded core laboratory analysis defined the culprit segment as the 10-mm segment distal to the proximal angiographic culprit margin. The remaining vessel was divided into contiguous 10-mm nonculprit segments. The maxLCBI4mm of culprit segments (median [interquartile range]: 543 [273-756]) was 4.4-fold greater than nonculprit segments (median [interquartile range]: 123 [0-307]; P<0.001). Receiver-operating characteristic analysis demonstrated that maxLCBI4mm differentiated culprit from nonculprit segments with high accuracy (c-statistic=0.83; P<0.001). A threshold maxLCBI4mm ≥400 identified STEMI culprit segments with a sensitivity of 64% and specificity of 85%.

CONCLUSIONS:

This study substantiates the ability of NIRS to accurately differentiate STEMI culprit from nonculprit segments and confirms that a threshold maxLCBI4mm ≥400 is detected by NIRS in the majority of STEMI culprits.

• Authors: Ryan D Madder, Rishi Puri, James E Muller, Jan Harnek, Matthias Götberg, Stacie VanOosterhout, Margaret Chi, David Wohns, Richard McNamara, Kathy Wolski, Sean Madden, Samuel Sidharta, Jordan Andrews, Stephen J Nicholls, David Erlinge
• Journal: Arteriosclerosis, thrombosis, and vascular biology (Arterioscler Thromb Vasc Biol) Vol. 36 Issue 5 Pg. 1010-5 (05 2016) ISSN: 1524-4636 [Electronic] United States
• PMID: 26941016 (Publication Type: Evaluation Study, Journal Article, Multicenter Study)
• Copyright: © 2016 American Heart Association, Inc.

Chemical References

• Lipids

Topics

• Aged
• Area Under Curve
• Coronary Angiography
• Coronary Artery Disease (diagnostic imaging, metabolism, pathology)
• Coronary Vessels (diagnostic imaging, metabolism, pathology)
• Diagnosis, Differential
• Female
• Humans
• Lipids (analysis)
• Male
• Michigan
• Middle Aged
• Plaque, Atherosclerotic
• Predictive Value of Tests
• ROC Curve
• Reproducibility of Results
• ST Elevation Myocardial Infarction (diagnostic imaging, metabolism, pathology)
• Spectroscopy, Near-Infrared
• Sweden
• Ultrasonography, Interventional