title: Detection by near-infrared spectroscopy of large lipid core plaques at culprit sites in patients with acute ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  This study sought to describe near-infrared spectroscopy (NIRS) findings of culprit lesions in ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Although autopsy studies demonstrate that most STEMI are caused by rupture of pre-existing lipid core plaque (LCP), it has not been possible to identify LCP in vivo. A novel intracoronary NIRS catheter has made it possible to detect LCP in patients.
  
  
  METHODS
  We performed NIRS within the culprit vessels of 20 patients with acute STEMI and compared the STEMI culprit findings to findings in nonculprit segments of the artery and to findings in autopsy control segments. Culprit and control segments were analyzed for the maximum lipid core burden index in a 4-mm length of artery (maxLCBI(4mm)).
  
  
  RESULTS
  MaxLCBI(4mm) was 5.8-fold higher in STEMI culprit segments than in 87 nonculprit segments of the STEMI culprit vessel (median [interquartile range (IQR)]: 523 [445 to 821] vs. 90 [6 to 265]; p < 0.001) and 87-fold higher than in 279 coronary autopsy segments free of large LCP by histology (median [IQR]: 523 [445 to 821] vs. 6 [0 to 88]; p < 0.001).Within the STEMI culprit artery, NIRS accurately distinguished culprit from nonculprit segments (receiver-operating characteristic analysis area under the curve = 0.90). A threshold of maxLCBI(4mm) >400 distinguished STEMI culprit segments from specimens free of large LCP by histology (sensitivity: 85%, specificity: 98%).
  
  
  CONCLUSIONS
  The present study has demonstrated in vivo that a maxLCBI(4mm) >400, as detected by NIRS, is a signature of plaques causing STEMI.
authors.affiliation: Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan 49503, USA. ryan.madder@spectrumhealth.org
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Madder
authors.forename: James A
authors.initials: JA
authors.lastname: Goldstein
authors.forename: Sean P
authors.initials: SP
authors.lastname: Madden
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.forename: Kathy
authors.initials: K
authors.lastname: Wolski
authors.forename: Michael
authors.initials: M
authors.lastname: Hendricks
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Sum
authors.forename: Annapoorna
authors.initials: A
authors.lastname: Kini
authors.forename: Samin
authors.initials: S
authors.lastname: Sharma
authors.forename: David
authors.initials: D
authors.lastname: Rizik
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: Kendrick A
authors.initials: KA
authors.lastname: Shunk
authors.forename: John
authors.initials: J
authors.lastname: Petersen
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: James E
authors.initials: JE
authors.lastname: Muller
mesh_terms: D019540:Area Under Curve; D016022:Case-Control Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D003331:Coronary Vessels / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008055:Lipids / Q000032:analysis*; D016015:Logistic Models; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012422:Rupture, Spontaneous; D019265:Spectroscopy, Near-Infrared; D018084:Ultrasonography, Interventional
chemical_list: D008055:Lipids
keywords: AUC; IQR; IVUS; LCBI; LCP; MaxLCBI(4mm); NIRS; PB; PCI; ST-segment elevation myocardial infarction; STEMI; TIMI; Thrombolysis In Myocardial Infarction; area under the curve; interquartile range; intravascular ultrasound; lipid core burden index; lipid core plaque; maximum lipid core burden index in 4 mm; myocardial infarction; near-infrared spectroscopy; percutaneous coronary intervention; plaque burden; vulnerable plaque