Impact of clinical presentations on lipid core plaque assessed by near-infrared spectroscopy intravascular ultrasound
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ORIGINAL PAPER
Impact of clinical presentations on lipid core plaque assessed by near‑infrared spectroscopy intravascular ultrasound Kazuya Tateishi1 · Hideki Kitahara1 · Yuichi Saito1 · Tadayuki Kadohira1 · Kan Saito1 · Takaaki Matsuoka1 · Naoto Mori1 · Takashi Nakayama1 · Yoshihide Fujimoto1 · Yoshio Kobayashi1 Received: 21 July 2020 / Accepted: 10 November 2020 © Springer Nature B.V. 2020
Abstract Near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) studies have demonstrated that lipid core plaque (LCP) is frequently observed in the culprit segment of myocardial infarction (MI). However, little is known about the impact of clinical presentations such as chronic coronary syndrome (CCS) and acute coronary syndrome (ACS) including unstable angina (UA), non ST-segment elevation MI (NSTEMI), and ST-segment elevation MI (STEMI) on LCP. The present prospective single-center registry included a total of 178 patients who underwent percutaneous coronary intervention under NIRS-IVUS guidance. Patients were divided into CCS and ACS groups, and ACS patients were further sub-divided into the 3 groups according to the clinical presentation. The primary endpoint was coronary LCP in the target lesion assessed by NIRS-IVUS with maximal lipid core burden index over any 4 mm segment ( maxLCBI4mm). The study population included 124 and 54 patients with CCS and ACS. MaxLCBI4mm in the target lesion was significantly higher in the ACS group than in the CCS group (503 [284–672] vs. 406 [250–557], p = 0.046). Among ACS patients, M axLCBI4mm in the target lesion was also significantly different in those with UA (n = 18), NSTEMI (n = 21), and STEMI (n = 15) (288 [162–524] vs. 518 [358–745] vs. 646 [394–848], p = 0.021). In conclusion, LCP assessed by NIRS-IVUS, a surrogate of coronary plaque vulnerability, was significantly different according to the clinical presentations such as CCS, UA, NSTEMI, and STEMI. Keywords Near-infrared spectroscopy-intravascular ultrasound · Acute coronary syndrome · Lipid core plaque · Vulnerability
Introduction Acute coronary syndrome (ACS) including unstable angina (UA), non ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI) is one of the major adverse cardiovascular events, leading to sudden cardiac arrest and death. Previous studies have revealed that ACS often develops from rupture of an underlying lipid core plaque (LCP) with thrombus formation [1, 2]. While various coronary imaging studies using intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have visualized the plaque instability in vivo [3, 4], near-infrared spectroscopy (NIRS)-IVUS has
been available as a unique intracoronary imaging method to specifically quantify lipid accumulation and detect LCP [5]. Culprit segments responsible for ACS, especially for STEMI, are more frequently composed of LCP compared with those for chronic coronary syndrome (CCS) [6–9]. While some previous reports compared LCP in patients between STEMI and NSTEMI or ACS and CCS
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