Near-infrared spectroscopy to predict microvascular obstruction after primary percutaneous coronary intervention
Kosei Terada1, Takashi Kubo, Ryan D Madder
1Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Insights
Lipid-rich plaque in coronary arteries, identified by near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS), predicts microvascular obstruction (MVO) after ST-elevation myocardial infarction (STEMI) treatment. This finding aids in understanding post-percutaneous coronary intervention outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Imaging
Background:
- Primary percutaneous coronary intervention (PPCI) restores epicardial artery patency in ST-elevation myocardial infarction (STEMI) but doesn't guarantee microvascular reperfusion.
- Microvascular obstruction (MVO) is a key determinant of infarct size and adverse outcomes post-STEMI.
Purpose of the Study:
- To investigate the association between lipid-rich coronary plaque, assessed by near-infrared spectroscopy combined with intravascular ultrasound (NIRS-IVUS), and MVO detected by cardiac magnetic resonance imaging (MRI) after PPCI for STEMI.
Main Methods:
- 120 STEMI patients undergoing PPCI were studied.
- NIRS-IVUS measured the maximum lipid core burden index in 4 mm (maxLCBI4 mm) of infarct-related lesions before PPCI.
- Delayed contrast-enhanced cardiac MRI assessed MVO one week post-PPCI.
Main Results:
- MVO occurred in 33% of patients.
- MaxLCBI4 mm was significantly larger in patients with MVO (745 vs 515, p<0.001).
- MaxLCBI4 mm independently predicted MVO (OR 24.7, p=0.006), with a maxLCBI4 mm >600 cut-off showing 75% sensitivity and 69% specificity for MVO prediction.
Conclusions:
- Lipid content in infarct-related lesions, measured by NIRS, is associated with MVO occurrence after PPCI in STEMI patients.
- NIRS-IVUS assessment of lipid-rich plaque may help identify patients at risk for MVO.
Background:
Successful restoration of epicardial coronary artery patency by primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) does not always lead to adequate reperfusion at the microvascular level.
Aims:
This study sought to investigate the association between lipid-rich coronary plaque identified by near-infrared spectroscopy combined with intravascular ultrasound (NIRS-IVUS) and microvascular obstruction (MVO) detected by cardiac magnetic resonance imaging (MRI) after PPCI for STEMI.
Methods:
We investigated 120 patients with STEMI undergoing PPCI. NIRS-IVUS was used to measure the maximum lipid core burden index in 4 mm (maxLCBI4 mm) in the infarct-related lesions before PPCI. Delayed contrast-enhanced cardiac MRI was performed to evaluate MVO one week after PPCI.
Results:
MVO was identified in 40 (33%) patients. MaxLCBI4 mm in the infarct-related lesion was significantly larger in the MVO group compared with the no-MVO group (median [interquartile range]: 745 [522-853] vs 515 [349-698], p<0.001). A multivariable logistic regression model showed that maxLCBI4 mm was an independent predictor of MVO (odds ratio: 24.7 [95% confidence interval: 2.5-248.0], p=0.006). Receiver operating characteristic curve analysis demonstrated that maxLCBI4 mm >600 was the optimal cut-off value to predict MVO (Youden index=0.44 and area under the curve=0.71) with a sensitivity of 75% and a specificity of 69%.
Conclusions:
Lipid content measured by NIRS in the infarct-related lesions was associated with the occurrence of MVO after PPCI in STEMI.
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