Intracoronary near-infrared spectroscopy and the risk of future cardiovascular events

Sofia Karlsson; Erik Anesäter; Klara Fransson; Pontus Andell; Jonas Persson; David Erlinge

doi:10.1136/openhrt-2018-000917

Intracoronary near-infrared spectroscopy and the risk of future cardiovascular events

Open Heart. 2019 Feb 9;6(1):e000917. doi: 10.1136/openhrt-2018-000917. eCollection 2019.

Authors

Sofia Karlsson¹, Erik Anesäter², Klara Fransson¹, Pontus Andell¹, Jonas Persson², David Erlinge¹

Affiliations

¹ Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
² Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.

Abstract

Objectives: The objectives of this study were to investigate if findings by intracoronary near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS) are associated with future cardiovascular events and if NIRS can differentiate culprit from non-culprit segments in patients with coronary artery disease.

Methods: The study included 144 patients with coronary artery disease undergoing percutaneous coronary intervention and combined NIRS-IVUS imaging at two Swedish hospitals. The NIRS-derived lipid core burden index (LCBI), the 4 mm segment with maximum LCBI (MaxLCBI_4mm) and the IVUS-derived maximum plaque burden (MaxPB) were analysed within the culprit segment and continuous 10 mm non-culprit segments of the index culprit vessels. The association with future major adverse cardiovascular and cerebrovascular events (MACCE), defined as all-cause mortality, acute coronary syndrome requiring revascularisation and cerebrovascular events during follow-up was evaluated using multivariable Cox regressions. A receiver operating characteristic (ROC) analysis was performed to test the ability of NIRS to discriminate culprit against non-culprit segments.

Results: A non-culprit maxLCBI_4mm ≥400 (HR: 3.67, 95% CI 1.46 to 9.23, p=0.006) and a non-culprit LCBI ≥ median (HR: 3.08, 95% CI 1.11 to 8.56, p=0.031) were both significantly associated with MACCE, whereas a non-culprit MaxPB ≥70% (HR: 0.61, 95% CI 0.08 to 4.59, p=0.63) was not. The culprit segments had larger lipid cores compared with non-culprit segments (MaxLCBI_4mm 425 vs 74, p<0.001), and the ROC analysis showed that NIRS can differentiate culprit against non-culprit segments (c-statistics: 0.85, 95% CI 0.81 to 0.89).

Conclusion: A maxLCBI_4mm ≥400 and LCBI ≥ median, assessed by NIRS in non-culprit segments of a culprit artery, were significantly associated with patient-level MACCE. NIRS furthermore adequately discriminated culprit against non-culprit segments in patients with coronary disease.

Keywords: intravascular ultrasound; lipid-rich plaques; near-infrared spectroscopy; vulnerable plaques.

Publication types

Research Support, Non-U.S. Gov't