Intravascular near-infrared spectroscopy (NIRS) imaging in mildly or non-obstructive coronary arteries can be used as a tool to identify both patients and non-culprit arteries at high risk for future events, based on findings from the Lipid-Rich Plaque (LRP) study presented Sept. 24 at TCT 2018. Ron Waksman, MD, FACC, who presented the results on behalf of the LRP investigators, also noted NIRS should be considered for use in patients undergoing cardiac catheterization with possible percutaneous coronary intervention (PCI).

From February 2014 to March 2016, a total of 1,563 patients with suspected coronary artery disease who underwent cardiac catheterization with PCI were enrolled at 44 sites in the U.S. and Europe. Imaging by NIRS-IVUS was performed in two or more arteries and patient level and plaque level events were detected for two years. Of those with patients with evaluable Lipid Core Burden Index4mm (LCBI4mm), those with maxLCBI4mm 250 or more were all followed up, while those with maxLCBI4mm less than 250 were randomly assigned 1:1 for follow-up.

Overall, the study met both of its co-primary endpoints. A vulnerable patient-level analysis, after adjustment, showed the risk of experiencing non-culprit major adverse cardiovascular events within 24 months was 18 percent higher with each 100 unit increase in maxLCBI4mm. Specifically, a patient with max LCBI4mm more than 400 was at 87 percent higher risk than a patient with <400 max LCBI4mm, researchers noted. In terms of vulnerable plaque-level analysis, the risk of experiencing an event in a coronary segment within 24 months was 45 percent higher with each 100 unit increase in max LCBI4mm. For example, a coronary segment with maxLCBI4mm more than 400 was at 411 percent higher risk than a segment with less than 400 max LCBI4mm.

"Multi-vessel NIRS can be easily and safely performed to assess and identify vulnerable patients and vulnerable plaques," said Waksman. He also noted that future studies for the use of NIRS-guided therapy should be conducted to address and mitigate the high risk of these patients and arteries.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Stable Ischemic Heart Disease, Interventions and Imaging, Angiography, Echocardiography/Ultrasound, Nuclear Imaging, Chronic Angina

Keywords: TCT18, Transcatheter Cardiovascular Therapeutics, Angiography, Percutaneous Coronary Intervention, Drug-Eluting Stents, Ultrasonography, Coronary Restenosis, Sirolimus

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