Author + information
- Ryan Madder,
- James Muller,
- Rishi Puri,
- Jan Harnek,
- Matthias Gotberg,
- Richard McNamara,
- David Wohns,
- Stacie Vanoosterhout,
- Kathy Wolski,
- Sean Madden,
- Stephen Nicholls and
- David Erlinge
A recent intracoronary near–infrared spectroscopy (NIRS) study identified a unique NIRS signature of culprit plaques in ST–segment elevation myocardial infarction (STEMI). We prospectively evaluated the frequency of this distinct NIRS signature at STEMI culprit sites.
At two centers in the United States and Sweden, we performed combined NIRS and intravascular ultrasound in STEMI culprit vessels after establishment of TIMI 3 flow, but prior to stent placement. The primary endpoint was the frequency of a maximum lipid core burden index in any 4–mm (maxLCBI4mm) greater than 400 within the culprit segment – a threshold derived from the prior study.
Among 21 consecutive STEMI patients (age 65 ± 13, 62% male), the culprit vessel was the right coronary artery in 52%, the left anterior descending artery in 33%, and the circumflex artery in 14%. Lipid core plaque was evident on the NIRS chemogram in 95% of culprit lesions, often in a circumferential pattern (Figure). STEMI culprit lesions were characterized by a maxLCBI4mm of 577 ± 219. MaxLCBI4mm>400 was present at the STEMI culprit site in 18 of the 21 cases (sensitivity = 85.7%).
This prospective multicenter analysis validates the use of maxLCBI4mm >400 by NIRS as a distinctive signature of STEMI culprit plaques. Validation of this signature, which is likely to be present prior to STEMI onset, supports conduct of a prospective outcomes study to identify targets for preventive therapy.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Interventional Aspects of CT and Other Novel Imaging Approaches
Abstract Category: 38. TCT@ACC–i2: Intravascular Imaging and Physiology
Presentation Number: 2112–262
- 2013 American College of Cardiology Foundation