signature=accf36ed72d125be89b816572528a5b1,TCT-23 Detection by Near-infrared Spectroscopy of Large L...

摘要：

Autopsy studies suggest most ST-segment elevation myocardial infarctions (STEMI) are caused by a ruptured lipid core plaque (LCP), yet this has not been demonstrated in vivo. A novel combined near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS) catheter can now accurately detect LCP in pts. We performed NIRS-IVUS in the culprit vessel of 18 consecutive STEMI pts (age 59±12; 83% male). To minimize alteration of the culprit plaque, NIRS-IVUS was performed after establishment of TIMI 3 flow by a guidewire, small balloon or aspiration, but prior to stent placement. LCP was quantitated as the lipid-core burden index (LCBI) over a 10mm vessel segment, a measure of the fraction of NIRS measurements indicating lipid. NIRS in STEMI pts was compared to findings in 329 stable coronary pts without MI (age 64±10; 79% male) and to autopsy specimens from 57 pts (age 65±10; 64% male) without histologic LCP. NIRS identified large, often circumferential LCP at the culprit site in 17 of 18 STEMI pts (94.4%; 3). The LCBI was 372±213 within the STEMI culprit vs 55±100 in 4325 segments in stable coronary pts (p<0.001) and vs 27±52 in 446 autopsy specimens without histologic LCPs (p<0.001; 13-fold lower than STEMI culprits). A NIRS signature of a large, often circumferential LCP was significantly more frequent at STEMI culprits than in comparable regions in stable pts and in autopsy specimens without LCPs. A prospective study is indicated to determine if such plaques detected by NIRS prior to rupture place pts at risk for future acute coronary events and cardiac death.

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