Log in to MyACC
Identification of Plaques Vulnerable to Future Coronary Events
Study Questions:
What is the relationship between lipid-rich plaques (LRPs) detected by near-infrared spectroscopy (NIRS)-intravascular ultrasound imaging at unstented sites and subsequent coronary events from new culprit lesions?
Methods:
The investigators conducted a prospective, cohort study (LRP), with patients from 44 medical centers in Italy, Latvia, Netherlands, Slovakia, United Kingdom, and the United States. Patients with suspected coronary artery disease who underwent cardiac catheterization with possible ad hoc percutaneous coronary intervention (PCI) were eligible to be enrolled. Enrolled patients underwent scanning of nonculprit segments using NIRS-intravascular ultrasound imaging. The study had two hierarchal primary hypotheses, patient and plaque, each testing the association between maximum 4 mm Lipid Core Burden Index (maxLCBI4mm) and nonculprit major adverse cardiovascular events (NC-MACE). Enrolled patients with large LRPs (≥250 maxLCBI4mm) and a randomly selected half of patients with small LRPs (<250 maxLCBI4mm) were followed up for 24 months. This study is registered with ClinicalTrials.gov, NCT02033694.
Results:
Between February 21, 2014, and March 30, 2016, 1,563 patients were enrolled. NIRS-intravascular ultrasound device-related events were seen in six (0.4%) patients. 1,271 patients (mean age 64 years, standard deviation 10,883 [69%] men, 388 [31%] women) with analyzable maxLCBI4mm were allocated to follow-up. The 2-year cumulative incidence of NC-MACE was 9% (n = 103). Both hierarchical primary hypotheses were met. On a patient level, the unadjusted hazard ratio (HR) for NC-MACE was 1.21 (95% confidence interval [CI], 1.09–1.35; p = 0.0004) for each 100-unit increase maxLCBI4mm) and adjusted HR 1.18 (95% CI, 1.05–1.32; p = 0.0043). In patients with a maxLCBI4mm more than 400, the unadjusted HR for NC-MACE was 2.18 (95% CI, 1.48–3.22; p < 0.0001) and adjusted HR was 1.89 (95% CI, 1.26–2.83; p = 0.0021). At the plaque level, the unadjusted HR was 1.45 (95% CI, 1.30–1.60; p < 0.0001) for each 100-unit increase in maxLCBI4mm. For segments with a maxLCBI4mm more than 400, the unadjusted HR for NC-MACE was 4.22 (95% CI, 2.39–7.45; p < 0.0001) and adjusted HR was 3.39 (95% CI, 1.85–6.20; p < 0.0001).
Conclusions:
The authors concluded that NIRS imaging can aid in identifying patients and segments at higher risk for subsequent nonculprit MACE.
Perspective:
This prospective intracoronary imaging study reports that NIRS-intravascular ultrasound imaging in mildly obstructed or nonobstructive coronary arteries can identify both patients and nonculprit segments in the coronary arteries at high risk for future events. Furthermore, a prespecified NIRS binary cutoff of 400 maxLCBI4mm is a reasonable predictor for subsequent events for the patient and the plaque levels. This study demonstrates that NIRS-intravascular ultrasound has the ability to detect NC-MACE in patients undergoing cardiac catheterization and possible PCI, and may be considered as a tool to guide patients and lesions at risk for unanticipated subsequent MACE. Additional studies for the use of NIRS-guided therapy are indicated to address and mitigate the high risk for MACE of these patients and arteries.
Clinical Topics: Acute Coronary Syndromes, Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Echocardiography/Ultrasound
Keywords: Atherosclerosis, Acute Coronary Syndrome, Cardiac Catheterization, Coronary Artery Disease, Diagnostic Imaging, Dyslipidemias, Percutaneous Coronary Intervention, Plaque, Atherosclerotic, Secondary Prevention, Spectroscopy, Near-Infrared, Ultrasonography
< Back to Listings
