• NEWS . 02 Mar 2020
  • Near-infrared spectroscopy intravascular ultrasound imaging shows promise as diagnostic tool for high-risk ACS patients

  • In a prospective cohort study of patients from 44 medical centres in Italy, Latvia, Netherlands, Slovakia, UK and the USA, near-infrared spectroscopy (NIRS) intravascular ultrasound imaging was shown to be a viable diagnostic tool for identifying patients and segments at higher risk of subsequent coronary events.

    The aim of this study was to examine the relationship between lipid-rich plaques (LRPs) detected by NIRS-intravascular ultrasound imaging at unstented sites and subsequent coronary events from new culprit lesions. Eligible patients underwent scanning of non-culprit segments using NIRS-intravascular ultrasound imaging. The two primary hierarchal endpoints, patient and plaque, were tested for their associations with maximum 4 mm Lipid Core Burden Index (maxLCBI4mm) and non-culprit major adverse cardiovascular events (NC-MACE). Enrolled patients with large LRPs (≥250 maxLCBI4mm) and a randomly selected half of patients with small LRPs (<250 maxLCBI4mm) were followed up for 24 months.

    Among the 1,563 patients enrolled between 21 February 2014 and 30 March 2016, six (0.4%) experienced NIRS-intravascular ultrasound device-related events; 1,271 patients with analysable maxLCBI4mm (mean age 64 years [standard deviation ±10]; 883 [69%] men and 388 [31%] women) were allocated to follow-up. The 2-year cumulative incidence of NC-MACE was 9% (n=103).

    On a patient level, every 100-unit increase in maxLCBI4mm was associated with an increased risk of NC-MACE (adjusted hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.05–1.32; p=0.0043). In patients with >400 maxLCBI4mm, adjusted HR was 1.89 (95% CI, 1.26–2.83; p=0.0021). At the plaque level, the unadjusted HR was 1.45 (95% CI, 1.30–1.60; p<0.0001) for each 100-unit increase in maxLCBI4mm. For segments with >400 maxLCBI4mm, unadjusted HR for NC-MACE was 4.22 (95% CI, 2.39–7.45; p<0.0001) and adjusted HR was 3.39 (95% CI, 1.85–6.20; p<0.0001).

    The study researchers concluded that NIRS imaging of non-obstructive territories in patients undergoing cardiac catheterization and possible percutaneous coronary intervention was safe, and can be used as a first-line diagnostic tool to detect vulnerable patients and plaques at risk of future NC-MACE.

    Waksman R, et al. Identification of patients and plaques vulnerable to future coronary events with near-infrared spectroscopy intravascular ultrasound imaging: a prospective, cohort study. Lancet 2019;394:1629-1637.