Author + information
- Jacob Bundya,b,
- Austin Clareya,b,
- Edwin Mandiekaa,b,
- Andrew LaCombea,b,
- David Benavidesa,b,
- Thomas Cranea,b,
- Manivannan Veerasamya,b,
- Stacie Vanoosterhouta,b,
- Abbey Muldera,b,
- Matthew Elmorea,b and
- Ryan Maddera,b
Background: A high coronary artery calcium score (CACS) indicates an increased risk for future coronary events, yet it is unknown whether patients having a high CACS harbor large lipid rich plaques (LRP) characteristic of lesions triggering myocardial infarction.
Methods: We performed multi-vessel intracoronary near-infrared spectroscopy (NIRS) and intravascular ultrasound in 20 asymptomatic individuals with no prior history of coronary disease who had a screening CACS ≥300 Agatston units. An LRP was defined as a lesion having ≥1 bright yellow block on the NIRS block chemogram. To quantify the lipid burden of each lesion, the maximum lipid core burden index in 4-mm (maxLCBI4mm) was recorded.
Results: The mean CACS of the study population was 764 ± 465 Agatston units. The presence of LRP was not universal, as 8 (40.0%) patients had no LRP detected by NIRS in any of their arteries. Large LRP having a maxLCBI4mm ≥400 were rare overall, found in only 5 (25.0%) individuals and in only 5 (1.9%) of 268 10-mm coronary segments analyzed. Two vessels having a high CACS but markedly different NIRS findings are shown (Figure).
Conclusions: This study, which is the first to report NIRS findings in asymptomatic individuals with a high CACS, demonstrates that a high CACS is not necessarily indicative of underlying LRP. This observed variation in coronary lipid suggests that NIRS imaging might be able to enhance risk stratification among asymptomatic individuals with a high CACS.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Interventional Cardiology: Stent Failure Analysis by Intravascuar Imaging
Abstract Category: 23. Interventional Cardiology: IVUS and Intravascular Physiology
Presentation Number: 1193-139
- 2017 American College of Cardiology Foundation