Coronary lipid-rich plaque characteristics in Japanese patients with acute coronary syndrome and stable angina: A near infrared spectroscopy and intravascular ultrasound study. (April 2021)

• Record Type: Journal Article
• Authors: Takahashi, Norihito; Dohi, Tomotaka; Endo, Hirohisa; Takeuchi, Mitsuhiro; Doi, Shinichiro; Kato, Yoshiteru; Okai, Iwao; Iwata, Hiroshi; Okazaki, Shinya; Isoda, Kikuo; Miyauchi, Katsumi; Minamino, Tohru
• Is Part Of: IJC heart & vasculature. Volume 33(2021)
• Publication Date: 2021-04
• Subjects: Vulnerable plaque -- NIRS -- Intracoronary imaging -- Lipid core burden index -- LCBI -- Asian; ACS acute coronary syndrome -- CI confidence interval -- CKD chronic kidney disease -- hs-CRP high-sensitive C reactive protein -- IL-6 interleukin-6 -- IQR interquartile range -- IVUS intravascular ultrasound -- LCBI lipid core burden index -- LDL-C low-density lipoprotein cholesterol -- LRP lipid-rich plaque -- MDA-LDL malondialdehyde-modified LDL -- MLA minimum lumen area -- NIRS near infrared spectroscopy -- NSTE-ACS non-ST elevation acute coronary syndrome -- OR odds ratio -- PCI percutaneous coronary intervention -- PCSK9 proprotein convertase subtilisin / kexin type 9 -- SA stable angina -- STEMI ST-elevation myocardial infarction -- TNF-α tumor necrosis factor-α; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2021.100747
• Languages: English
• ISSNs: 2352-9067

Abstract

Highlights: This study aimed to evaluate the characteristics of lipid-rich plaque (LRP) in Japanese. The maxLCBI4mm significantly predicted acute coronary syndrome culprit lesion. Almost 20% of patients had at least one high-risk LRP in non-culprit lesion segment in same vessel. No surrogate maker (lipids and inflammation) for a high-risk LRP was found. Direct intravascular evaluation of plaque characteristics remains important. Abstract: Background: Asians have a much lower incidence of adverse coronary events than Caucasians. We sought to evaluate the characteristics of coronary lipid-rich plaques (LRP) in Asian patients with acute coronary syndrome (ACS) and stable angina (SA). We also aimed to identify surrogate markers for the extent of LRP. Methods: We evaluated 207 patients (ACS, n = 75; SA, n = 132) who underwent percutaneous coronary intervention under near infrared spectroscopy intravascular ultrasound (NIRS-IVUS). Plaque characteristics and the extent of LRP [defined as a long segment with a 4-mm maximum lipid-core burden index (maxLCBI4mm )] on NIRS in de-novo culprit and non-culprit segments were analyzed. Results: The ACS culprit lesions had a significantly higher maxLCBI4mm (median [interquartile range (IQR)]: 533 [385–745] vs. 361 [174–527], p < 0.001) than the SA culprit lesions. On multivariate logistic analysis, a large LRP (defined as maxLCBI4mm ≥ 400) was the strongest independent predictor of the ACS culprit segment (odds ratio, 3.87; 95% confidence interval, 1.95–8.02). In non-culprit segments, 19.8% of patients had at least one large LRP without a small lumen. No significant correlation was found between the extent of LRP and systematic biomarkers (hs-CRP, IL-6, TNF-α), whereas the extent of LRP was positively correlated with IVUS plaque burden (r = 0.24, p < 0.001). Conclusions: We confirmed that NIRS-IVUS plaque assessment could be useful to differentiate ACS from SA culprit lesions, and that a threshold maxLCBI4mm ≥ 400 was clinically suitable in Japanese patients. No surrogate maker for a high-risk LRP was found; consequently, direct intravascular evaluation of plaque characteristics remains important.