title: Detection by near-infrared spectroscopy of large lipid cores at culprit sites in patients with non-ST-segment elevation myocardial infarction and unstable angina.
abstract: OBJECTIVE
  This study was performed to assess the lipid burden of culprit lesions in non-ST-segment elevation myocardial infarction (non-STEMI) and unstable angina (UA).
  
  
  BACKGROUND
  A recent intracoronary near-infrared spectroscopy (NIRS) study showed 85% of STEMI culprit lesions have a maximum lipid core burden index in 4-mm (maxLCBI(4mm)) ≥ 400. Whether culprit lesions in non-STEMI and UA are characterized by a similarly large lipid burden is unknown.
  
  
  METHODS
  We studied 81 non-STEMI and UA patients undergoing culprit vessel NIRS imaging before stenting. Culprit segments were compared to all nonoverlapping 10-mm nonculprit segments for maxLCBI(4mm). Culprit segments in non-STEMI and UA were compared for the frequency of maxLCBI(4mm) ≥ 400.
  
  
  RESULTS
  Among 81 patients (53.1% non-STEMI, 46.9% UA), non-STEMI culprit segments had a 3.4-fold greater maxLCBI(4mm) than nonculprits (448 ± 229 vs 132 ± 154, P < 0.001) and UA culprit segments had a 2.6-fold higher maxLCBI(4mm) than nonculprits (381 ± 239 vs 146 ± 175, P < 0.001). NIRS detected a maxLCBI(4mm) ≥ 400 in 63.6% of culprit segments in NSTEMI and in 38.5% of culprit segments in UA (P = 0.02). Against a background of nonculprit segments, maxLCBI(4mm) ≥ 400 had a sensitivity of 63.6% and specificity of 94.0% for culprit segments in NSTEMI and a sensitivity of 38.5% and specificity of 89.8% for culprit segments in UA.
  
  
  CONCLUSIONS
  Large lipid cores similar to those recently detected by NIRS at STEMI culprit sites were frequently observed at culprit sites in patients with non-STEMI and UA. These findings support ongoing prospective trials designed to determine if NIRS can provide site-specific prediction of future acute coronary events.
authors.affiliation: Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Madder
authors.affiliation: Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Husaini
authors.affiliation: Department of Surgery, Michigan State University, Lansing, Michigan.|Research Department, Grand Rapids Medical Education Partners, Grand Rapids, Michigan.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.affiliation: Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan.
authors.forename: Stacie
authors.initials: S
authors.lastname: VanOosterhout
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Harnek
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden.
authors.forename: Matthias
authors.initials: M
authors.lastname: Götberg
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
mesh_terms: D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000628:therapy; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D058226:Plaque, Atherosclerotic / Q000175:diagnosis* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D013548:Sweden
keywords: acute coronary syndrome; lipid core plaque; near-infrared spectroscopy