Detection of lipid-core plaques by intracoronary near-infrared spectroscopy identifies high risk of periprocedural myocardial infarction

James A. Goldstein, Brijeshwar Maini, Simon R. Dixon, Emmanouil S. Brilakis, Cindy L. Grines, David G. Rizik, Eric R. Powers, Daniel H. Steinberg, Kendrick A. Shunk, Giora Weisz, Pedro R. Moreno, Annapoorna Kini, Samin K. Sharma, Michael J. Hendricks, Steve T. Sum, Sean P. Madden, James E. Muller, Gregg W. Stone, Morton J. Kern

Research output: Contribution to journalArticle

136 Scopus citations

Abstract

Background-Percutaneous coronary intervention (PCI) is associated with periprocedural myocardial infarction (MI) in 3% to 15% of cases (depending on the definition used). In many cases, these MIs result from distal embolization of lipid-core plaque (LCP) constituents. Prospective identification of LCP with catheter-based near-infrared spectroscopy (NIRS) may predict an increased risk of periprocedural MI and facilitate development of preventive measures. Methods and Results-The present study analyzed the relationship between the presence of a large LCP (detected by NIRS) and periprocedural MI. Patients with stable preprocedural cardiac biomarkers undergoing stenting were identified from the COLOR Registry, an ongoing prospective observational study of patients undergoing NIRS before PCI. The extent of LCP in the treatment zone was calculated as the maximal lipid-core burden index (LCBI) measured by NIRS for each of the 4-mm longitudinal segments in the treatment zone. A periprocedural MI was defined as new cardiac biomarker elevation above 3 × upper limit of normal. A total of 62 patients undergoing stenting met eligibility criteria. A large LCP (defined as a maxLCBI 4mm ≥ 500) was present in 14 of 62 lesions (22.6%), and periprocedural MI was documented in 9 of 62 (14.5%) of cases. Periprocedural MI occurred in 7 of 14 patients (50%) with a maxLCBI 4mm ≥ 500, compared with 2 of 48 patients (4.2%) patients with a lower maxLCBI 4mm (P=0.0002). Conclusions-NIRS provides rapid, automated detection of extensive LCPs that are associated with a high risk of periprocedural MI, presumably due to embolization of plaque contents during coronary intervention.

Original languageEnglish (US)
Pages (from-to)429-437
Number of pages9
JournalCirculation: Cardiovascular Interventions
Volume4
Issue number5
DOIs
StatePublished - Oct 1 2011

Keywords

  • Distal embolization
  • Lipid-core plaque
  • Near-infrared spectroscopy
  • Percutaneous coronary intervention
  • Periprocedural myocardial infarction
  • Plaque characterization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Detection of lipid-core plaques by intracoronary near-infrared spectroscopy identifies high risk of periprocedural myocardial infarction'. Together they form a unique fingerprint.

  • Cite this

    Goldstein, J. A., Maini, B., Dixon, S. R., Brilakis, E. S., Grines, C. L., Rizik, D. G., Powers, E. R., Steinberg, D. H., Shunk, K. A., Weisz, G., Moreno, P. R., Kini, A., Sharma, S. K., Hendricks, M. J., Sum, S. T., Madden, S. P., Muller, J. E., Stone, G. W., & Kern, M. J. (2011). Detection of lipid-core plaques by intracoronary near-infrared spectroscopy identifies high risk of periprocedural myocardial infarction. Circulation: Cardiovascular Interventions, 4(5), 429-437. https://doi.org/10.1161/CIRCINTERVENTIONS.111.963264