In vivo validation of a catheter-based near-infrared spectroscopy system for detection of lipid core coronary plaques: initial results of the SPECTACL study.
OBJECTIVE
To determine whether catheter-based near-infrared spectroscopy (NIRS) signals obtained with a novel catheter-based system from coronaries of patients are similar to those from autopsy specimens and to assess initial safety of NIRS device.


BACKGROUND
An intravascular NIRS system for detection of lipid core-containing plaques (LCP) has been validated in human coronary autopsy specimens. The SPECTACL (SPECTroscopic Assessment of Coronary Lipid) trial was a parallel first-in-human multicenter study designed to demonstrate the applicability of the LCP detection algorithm in living patients.


METHODS
Intracoronary NIRS was performed in patients undergoing percutaneous coronary intervention. Acquired spectra were blindly compared with autopsy NIRS signals with multivariate statistics. To meet the end point of spectral similarity, at least two-thirds of the scans were required to have >80% of spectra similar to the autopsy spectra.


RESULTS
A total of 106 patients were enrolled; there were no serious adverse events attributed to NIRS. Spectroscopic data could not be obtained in 17 (16%) patients due to technical limitations, leaving 89 patients for analysis. Spectra from 30 patients were unblinded to test the calibration of the LCP detection algorithm. Of the remaining 59 blinded cases, after excluding 11 due to inadequate data, spectral similarity was demonstrated in 40 of 48 spectrally adequate scans (83% success rate, 95% confidence interval: 70% to 93%, median spectral similarity/pullback: 96%, interquartile range 10%). The LCP was detected in 58% of 60 spectrally similar scans from both cohorts.


CONCLUSIONS
This intravascular NIRS system safely obtained spectral data in patients that were similar to those from autopsy specimens. These results demonstrate the feasibility of invasive detection of coronary LCP with this novel system. (SPECTACL: SPECTroscopic Assessment of Coronary Lipid; NCT00330928).
Waxman
Sergio
S
Lahey Clinic, Burlington, Massachusetts 01805, USA. Sergio.Waxman@lahey.org
Dixon
Simon R
SR
L'Allier
Philippe
P
Moses
Jeffrey W
JW
Petersen
John L
JL
Cutlip
Donald
D
Tardif
Jean-Claude
JC
Nesto
Richard W
RW
Muller
James E
JE
Hendricks
Michael J
MJ
Sum
Stephen T
ST
Gardner
Craig M
CM
Goldstein
James A
JA
Stone
Gregg W
GW
Krucoff
Mitchell W
MW
D000368:Aged; D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary; D001344:Autopsy; D006328:Cardiac Catheterization / Q000295:instrumentation; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy; D003331:Coronary Vessels / Q000737:chemistry* / Q000473:pathology; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008055:Lipids / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D019265:Spectroscopy, Near-Infrared / Q000295:instrumentation; D014481:United States
D008055:Lipids