Detection by near-infrared spectroscopy of large lipid cores at culprit sites in patients with non-st-segment elevation myocardial infarction and unstable angina

Ryan D. Madder, Mustafa Husaini, Alan T. Davis, Stacie Van Oosterhout, Jan Harnek, Matthias Götberg, David Erlinge

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Objective This study was performed to assess the lipid burden of culprit lesions in non-ST-segment elevation myocardial infarction (non-STEMI) and unstable angina (UA). Background A recent intracoronary near-infrared spectroscopy (NIRS) study showed 85% of STEMI culprit lesions have a maximum lipid core burden index in 4-mm (maxLCBI4mm) ≥ 400. Whether culprit lesions in non-STEMI and UA are characterized by a similarly large lipid burden is unknown. Methods We studied 81 non-STEMI and UA patients undergoing culprit vessel NIRS imaging before stenting. Culprit segments were compared to all nonoverlapping 10-mm nonculprit segments for maxLCBI4mm. Culprit segments in non-STEMI and UA were compared for the frequency of maxLCBI4mm ≥ 400. Results Among 81 patients (53.1% non-STEMI, 46.9% UA), non-STEMI culprit segments had a 3.4-fold greater maxLCBI4mm than nonculprits (448 ± 229 vs 132 ± 154, P < 0.001) and UA culprit segments had a 2.6-fold higher maxLCBI4mm than nonculprits (381 ± 239 vs 146 ± 175, P < 0.001). NIRS detected a maxLCBI4mm ≥ 400 in 63.6% of culprit segments in NSTEMI and in 38.5% of culprit segments in UA (P = 0.02). Against a background of nonculprit segments, maxLCBI4mm ≥ 400 had a sensitivity of 63.6% and specificity of 94.0% for culprit segments in NSTEMI and a sensitivity of 38.5% and specificity of 89.8% for culprit segments in UA. Conclusions Large lipid cores similar to those recently detected by NIRS at STEMI culprit sites were frequently observed at culprit sites in patients with non-STEMI and UA. These findings support ongoing prospective trials designed to determine if NIRS can provide site-specific prediction of future acute coronary events.

Original languageEnglish
Pages (from-to)1014-1021
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume86
Issue number6
DOIs
StatePublished - Nov 15 2015
Externally publishedYes

Keywords

  • acute coronary syndrome
  • lipid core plaque
  • near-infrared spectroscopy

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