Near-infrared spectroscopy to predict microvascular obstruction after primary percutaneous coronary intervention.

医学 四分位间距 心脏病学 经皮冠状动脉介入治疗 内科学 心肌梗塞 接收机工作特性 置信区间 优势比 曲线下面积 血管内超声 放射科
作者
Kosei Terada,Takashi Kubo,Ryan D Madder,Yasushi Ino,Masahiro Takahata,Kunihiro Shimamura,Yasutsugu Shiono,Takahiro Nishi,Hiroki Emori,Daisuke Higashioka,Amir Kh M Khalifa,Teruaki Wada,Takashi Akasaka
出处
期刊:Eurointervention [European Association of Percutaneous Cardiovascular Interventions]
卷期号:17 (12): e999-e1006
标识
DOI:10.4244/eij-d-20-01421
摘要

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.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.We investigated 120 patients with STEMI undergoing PPCI. NIRS-IVUS was used to measure the maximum lipid core burden index in 4 mm (maxLCBI4 mm) in the infarct-related lesions before PPCI. Delayed contrast-enhanced cardiac MRI was performed to evaluate MVO one week after PPCI.MVO was identified in 40 (33%) patients. MaxLCBI4 mm 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). A multivariable logistic regression model showed that maxLCBI4 mm 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 maxLCBI4 mm >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%.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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