Can J Cardiol. 2023 Jun 13:S0828-282X(23)00455-5. doi: 10.1016/j.cjca.2023.06.005. Online ahead of print.
ABSTRACT
BACKGROUND: Lipid-rich plaque detected by near-infrared spectroscopy (NIRS) and attenuated plaque detected by intravascular ultrasound (IVUS) predict periprocedural myocardial injury (MI) following percutaneous coronary intervention (PCI). Although echolucent plaque by IVUS was reported to be associated with a no-reflow phenomenon in acute myocardial infarction, it remains unclear whether echolucent plaque is predictive of periprocedural MI following elective PCI. We aimed to elucidate whether echolucent plaque is independently associated with periprocedural MI following elective PCI and whether the predictive ability for periprocedural MI is improved by the combination of NIRS and IVUS.
METHODS: This retrospective study included 121 lesions of 121 patients who underwent elective NIRS-IVUS-guided stent implantation. Periprocedural MI was defined as post-PCI cardiac troponin-T >70 ng/L. Maximum 4-mm lipid core burden index >457 was regarded as lipid-rich plaque. Echolucent plaque and attenuated plaque were defined as the presence of an echolucent zone and an attenuation arc >90° on IVUS, respectively.
RESULTS: Periprocedural MI occurred in 39 lesions. In multivariable analysis, echolucent plaque, attenuated plaque, and lipid-rich plaque were independent predictors of periprocedural MI. Adding echolucent plaque and attenuated plaque to lipid-rich plaque improved the predictive performance (C-statistics: 0.825 vs. 0.688; p=0.001). Periprocedural MI increased with the number of predictors (3% [1/39], 29% [10/34], 47% [14/30], and 78% [14/18] for 0, 1, 2, and 3 predictors, respectively; p<0.001).
CONCLUSIONS: Echolucent plaque is a major predictor of periprocedural MI, independent of lipid-rich plaque and attenuated plaque. Compared with NIRS alone, the combination of NIRS with IVUS signatures improves the predictive ability.
PMID:37321347 | DOI:10.1016/j.cjca.2023.06.005
