Quick Take: Identification of patients and plaques vulnerable to future coronary events with near-infrared spectroscopy intravascular ultrasound imaging

1. Near-infrared spectroscopy imaging in patients undergoing cardiac catheterization for suspected coronary artery disease can be used in identifying high-risk non-culprit lesions contributing to future major adverse coronary events. 

Evidence Rating Level: 2 (Good)

Coronary artery disease is the leading cause of death worldwide. While modifiable risk factors are the target of reducing the risk of developing atherosclerosis, and therefore, coronary artery events, there are now increased efforts to identify vulnerable coronary plaques that are at an elevated risk of rupture. Near-infrared spectroscopy (NIRS) intravascular ultrasound imaging can be used to identify lipid-rich plaques (LRP). In this prospective cohort study, 1563 patients with suspected coronary artery disease undergoing cardiac catheterization with possible ad-hoc percutaneous coronary intervention (PCI) also underwent NIRS scanning of non-culprit segments to establish the relationship between LRPs detected by NIRS-intravascular ultrasound imaging at unstented sites and subsequent coronary events from new culprit lesions. As part of inclusion criteria in the study, patients must have had at least 50 mm of non-stented NIRS-intravascular ultrasound imaging data from at least two major coronary arteries. Of the patients that underwent NIRS intravascular ultrasound imaging, 1271 with analyzable maximum 4 mm lipid core burden index (maxLCBI) were followed up. The 2-year incidence of non-culprit major adverse coronary events (NC-MACE) was 9% (n=103). Researchers found that for each 100-unit increase in maxLCBI, patients had an increased risk of NC-MACE (HR 1.18, 95% CI 1.05 to 1.32, p=0.0043). This risk was further increased when assessing patients with a maxLCBI greater than 400 when compared to patients with a maxLCBI of 400 or less (HR 1.89, 95% CI 1.26 to 2.83, p=0.0021). This study therefore shows that NIRS imaging in patients undergoing cardiac catheterization for suspected coronary artery disease can be used in identifying high-risk non-culprit lesions. The findings of this study have important implications in reducing the risk of major adverse coronary events in a high-risk group.

Click to read the study in Lancet

Image: PD

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