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Original research article
Intracoronary near-infrared spectroscopy and the risk of future cardiovascular events
  1. Sofia Karlsson1,
  2. Erik Anesäter2,
  3. Klara Fransson1,
  4. Pontus Andell1,
  5. Jonas Persson2 and
  6. David Erlinge1
  1. 1 Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
  2. 2 Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
  1. Correspondence to Sofia Karlsson; sofia.karlsson{at}med.lu.se

Abstract

Objectives The objectives of this study were to investigate if findings by intracoronary near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS) are associated with future cardiovascular events and if NIRS can differentiate culprit from non-culprit segments in patients with coronary artery disease.

Methods The study included 144 patients with coronary artery disease undergoing percutaneous coronary intervention and combined NIRS-IVUS imaging at two Swedish hospitals. The NIRS-derived lipid core burden index (LCBI), the 4 mm segment with maximum LCBI (MaxLCBI4mm) and the IVUS-derived maximum plaque burden (MaxPB) were analysed within the culprit segment and continuous 10 mm non-culprit segments of the index culprit vessels. The association with future major adverse cardiovascular and cerebrovascular events (MACCE), defined as all-cause mortality, acute coronary syndrome requiring revascularisation and cerebrovascular events during follow-up was evaluated using multivariable Cox regressions. A receiver operating characteristic (ROC) analysis was performed to test the ability of NIRS to discriminate culprit against non-culprit segments.

Results A non-culprit maxLCBI4mm ≥400 (HR: 3.67, 95% CI 1.46 to 9.23, p=0.006) and a non-culprit LCBI ≥ median (HR: 3.08, 95% CI 1.11 to 8.56, p=0.031) were both significantly associated with MACCE, whereas a non-culprit MaxPB ≥70% (HR: 0.61, 95% CI 0.08 to 4.59, p=0.63) was not. The culprit segments had larger lipid cores compared with non-culprit segments (MaxLCBI4mm 425 vs 74, p<0.001), and the ROC analysis showed that NIRS can differentiate culprit against non-culprit segments (c-statistics: 0.85, 95% CI 0.81 to 0.89).

Conclusion A maxLCBI4mm ≥400 and LCBI ≥ median, assessed by NIRS in non-culprit segments of a culprit artery, were significantly associated with patient-level MACCE. NIRS furthermore adequately discriminated culprit against non-culprit segments in patients with coronary disease.

  • near-infrared spectroscopy
  • intravascular ultrasound
  • lipid-rich plaques
  • vulnerable plaques

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

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Footnotes

  • Contributors DE contributed with the study design, patient enrolment, data collection, revised the draft paper and is the overall responsible author for this study. SK contributed with the study design, cleaned and analysed the data including imaging and statistical analyses and drafted and revised the manuscript. EA contributed with the study design, cleaned and analysed the data including imaging analyses and revised the draft paper. KF analysed the data including imaging and statistical analyses and drafted and revised the manuscript. PA contributed to the study design and statistical plan and revised the draft paper. JP contributed with study design, patient enrolment, data collection and revised the draft paper.

  • Funding This work was supported by The Swedish Heart and Lung Foundation, Swedish Scientific Research Council, Knut and Alice Wallenbergs Foundation, Stockholm County Council ALF project (20140076/20150422) and postdoctoral appointment (20130339).

  • Competing interests None declared.

  • Patient consent Not required.

  • Data sharing statement No additional data are available.

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