Abstract
BackgroundNear-infrared spectroscopy (NIRS) provides the localization of lipid-rich components in coronary plaques. However, morphological features in NIRS-detected lipid-rich plaques (LRP) are unclear.MethodsA total of 140 de novo culprit lesions in 140 patients with the acute coronary syndrome (ACS) who underwent NIRS and optical coherence tomography (OCT) examinations for the culprit lesions at the time of percutaneous coronary interventions were investigated. We defined a NIRS-LRP as a lesion with a maximum lipid core burden index of 4 mm [LCBI4mm] > 500 in the culprit plaque. Clinical demographics, angiographic, and OCT findings were compared between the patients with NIRS-LRP (n = 54) vs. those without NIRS-LRP (n = 86). Uni- and multivariable logistic regression analyses were performed to examine the independent OCT morphological predictors for NIRS-LRP.ResultsClinical demographics showed no significant differences between the two groups. The angiographic minimum lumen diameter was smaller in the NIRS-LRP group than in the non- NIRS-LRP group. In OCT analysis, the minimum flow area was smaller; lipid angle, lipid length, the prevalence of thin-cap fibroatheroma, and cholesterol crystals were greater in the NIRS-LRP group than in the non-NIRS-LRP group. Plaque rupture and thrombi were more frequent in the NIRS-LRP group, albeit not significant. In a multivariable logistic regression analysis, presence of thin-cap fibroatheroma [odds ratio (OR): 2.56; 95% CI: 1.12 to 5.84; p = 0.03] and cholesterol crystals (OR: 2.90; 95% CI: 1.20 to 6.99; p = 0.02) were independently predictive of NIRS-LRP.ConclusionsIn ACS culprit lesions, OCT-detected thin-cap fibroatheroma and cholesterol crystals rather than plaque rupture and thrombi were closely associated with a great lipid-core burden.
Highlights
Near-infrared spectroscopy (NIRS) is a novel modality useful to identify lipid-rich plaques prone to progress [1, 2]
In optical coherence tomography (OCT) analysis, the minimum flow area was smaller; lipid angle, lipid length, the prevalence of thin-cap fibroatheroma, and cholesterol crystals were greater in the NIRS-lipid-rich plaques (LRP) group than in the non-NIRS-LRP group
In a multivariable logistic regression analysis, presence of thin-cap fibroatheroma [odds ratio (OR): 2.56; 95% CI: 1.12 to 5.84; p = 0.03] and cholesterol crystals (OR: 2.90; 95% CI: 1.20 to 6.99; p = 0.02) were independently predictive of NIRS-LRP
Summary
Near-infrared spectroscopy (NIRS) is a novel modality useful to identify lipid-rich plaques prone to progress [1, 2]. Several previous studies compared NIRS-IVUS and optical coherence tomography (OCT) findings and showed associations between NIRS-detected great lipid core burden index (LCBI) and OCT-detected plaque vulnerability in stable patients [5] and non-infarct-related arteries [6]. A NIRS-IVUS and OCT study [7] has proposed NIRS-IVUS-derived criteria to predict the OCTderived plaque morphologies of the culprit lesions of acute myocardial infarction. This study aimed to examine (i) the relation between OCT-derived plaque morphologies and great LCBI and (ii) the OCT-derived lipid-related predictors of great LCBI in culprit lesions in patients with ACS. Near-infrared spectroscopy (NIRS) provides the localization of lipid-rich components in coronary plaques. Morphological features in NIRS-detected lipid-rich plaques (LRP) are unclear
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