Clinical outcomes of acute myocardial infarction arising from non-lipid-rich plaque determined by NIRS-IVUS.

Abstract

Acute myocardial infarction (AMI) can rarely arise from non-lipid-rich coronary plaques. This study sought to compare the clinical outcomes after percutaneous coronary intervention (PCI) between AMI showing maximum lipid-core burden index in 4 mm (maxLCBI4mm) < 400 and ≥ 400 in the infarct-related lesions assessed by near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS). We investigated 426 AMI patients who underwent NIRS-IVUS in the infarct-related lesions before PCI. Major adverse cardiovascular events (MACE) were defined as the composite of cardiac death, non-fatal MI, clinically driven target lesion revascularization (TLR), clinically driven non-TLR, and congestive heart failure requiring hospitalization. 107 (25%) patients had infarct-related lesions of maxLCBI4mm < 400, and 319 (75%) patients had those of maxLCBI4mm ≥ 400. The maxLCBI4mm < 400 group had a younger median age at onset (68 years [IQR: 57-78 years] vs. 73 years [IQR: 64-80 years], P = 0.007), less frequent multivessel disease (39% vs. 51%, P = 0.029), less frequent TIMI flow grade 0 or 1 before PCI (62% vs. 75%, P = 0.007), and less frequent no-reflow immediately after PCI (5% vs. 11%, P = 0.039). During a median follow-up period of 31 months [IQR: 19-48 months], the frequency of MACE was significantly lower in the maxLCBI4mm < 400 group compared with the maxLCBI4mm ≥ 400 group (4.7% vs. 17.2%, P = 0.001). MaxLCBI4mm < 400 was an independent predictor of MACE-free survival at multivariable analysis (hazard ratio: 0.36 [confidence interval: 0.13-0.98], P = 0.046). MaxLCBI4mm < 400 measured by NIRS in the infract-related lesions before PCI was associated with better long-term clinical outcomes in AMI patients.

• Authors: Kosei Terada, Noriyuki Wakana, Takashi Kubo, Yasushi Ino, Amir Kh M Khalifa, Suwako Fujita, Masahiro Takahata, Yasutsugu Shiono, Ryan D Madder, Takeyoshi Kameyama
• Journal: Scientific reports (Sci Rep) Vol. 13 Issue 1 Pg. 11544 (07 17 2023) ISSN: 2045-2322 [Electronic] England
• PMID: 37460602 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2023. The Author(s).

Topics

• Humans
• Middle Aged
• Aged
• Coronary Artery Disease (diagnostic imaging, therapy, complications)
• Percutaneous Coronary Intervention (adverse effects)
• Spectroscopy, Near-Infrared
• Ultrasonography, Interventional
• Myocardial Infarction (complications)
• Plaque, Atherosclerotic (etiology)
• Treatment Outcome
• Coronary Angiography
• Coronary Vessels (diagnostic imaging)