The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Near-Infrared Spectroscopy to Predict Microvascular Obstruction after Primary Percutaneous Coronary Intervention

DOI: 10.4244/EIJ-D-20-01421

1. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan, Japan
2. Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan, USA

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Background. Successful restoration of epicardial coronary artery patency by primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) does not always lead to adequate reperfusion at the microvascular level.

Aims. This study sought to investigate the association between lipid-rich coronary plaque identified by near-infrared spectroscopy combined with intravascular ultrasound (NIRS-IVUS) and microvascular obstruction (MVO) detected by cardiac magnetic resonance imaging (MRI) after PPCI for STEMI.

Methods. We investigated 120 patients with STEMI undergoing PPCI. NIRS-IVUS was used to measure the maximum lipid-core burden index in 4 mm (maxLCBI4mm) in the infarct-related lesions before PPCI. Delayed contrast-enhanced cardiac MRI was performed to evaluate MVO 1 week after PPCI.

Results. MVO was identified in 40 (33%) patients. MaxLCBI4mm in the infarct-related lesion was significantly larger in the MVO group compared with the no-MVO group (median [interquartile range]: 745 [522–853] vs. 515 [349–698], p<0.001). Multivariable logistic regression model showed that maxLCBI4mm was an independent predictor of MVO (odds ratio: 24.7 [95% confidence interval: 2.5–248.0], p=0.006). Receiver-operating characteristic curve analysis demonstrated that maxLCBI4mm >600 was the optimal cut-off value to predict MVO (Youden index = 0.44 and area under the curve = 0.71) with a sensitivity of 75% and a specificity of 69%.

Conclusions. Lipid content measured by NIRS in the infarct-related lesions was associated with the occurrence of MVO after PPCI in STEMI.

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