title: Plaque Characterization to Inform the Prediction and Prevention of Periprocedural Myocardial Infarction During Percutaneous Coronary Intervention: The CANARY Trial (Coronary Assessment by Near-infrared of Atherosclerotic Rupture-prone Yellow).
abstract: OBJECTIVE
  This study sought to determine whether pre-percutaneous coronary intervention (PCI) plaque characterization using near-infrared spectroscopy identifies lipid-rich plaques at risk of periprocedural myonecrosis and whether these events may be prevented by the use of a distal protection filter during PCI.
  
  
  BACKGROUND
  Lipid-rich plaques may be prone to distal embolization and periprocedural myocardial infarction (MI) in patients undergoing PCI.
  
  
  METHODS
  Patients undergoing stent implantation of a single native coronary lesion were enrolled in a multicenter, prospective trial. Near-infrared spectroscopy and intravascular ultrasound were performed at baseline, and lesions with a maximal lipid core burden index over any 4-mm length (maxLCBI4mm) ≥600 were randomized to PCI with versus without a distal protection filter. The primary endpoint was periprocedural MI, defined as troponin or a creatine kinase-myocardial band increase to 3 or more times the upper limit of normal.
  
  
  RESULTS
  Eighty-five patients were enrolled at 9 U.S. sites. The median (interquartile range) maxLCBI4mm was 448.4 (274.8 to 654.4) pre-PCI and decreased to 156.0 (75.6 to 312.6) post-PCI (p < 0.0001). Periprocedural MI developed in 21 patients (24.7%). The maxLCBI4mm was higher in patients with versus without MI (481.5 [425.6 to 679.6] vs. 371.5 [228.9 to 611.6], p = 0.05). Among 31 randomized lesions with maxLCBI4mm ≥600, there was no difference in the rates of periprocedural MI with versus without the use of a distal protection filter (35.7% vs. 23.5%, respectively; relative risk: 1.52; 95% confidence interval: 0.50 to 4.60, p = 0.69).
  
  
  CONCLUSIONS
  Plaque characterization by near-infrared spectroscopy identifies lipid-rich lesions with an increased likelihood of periprocedural MI after stent implantation, presumably due to distal embolization. However, in this pilot randomized trial, the use of a distal protection filter did not prevent myonecrosis after PCI of lipid-rich plaques.
authors.affiliation: Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York; The Cardiovascular Research Foundation, New York, New York. Electronic address: gs2184@columbia.edu.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York; The Cardiovascular Research Foundation, New York, New York.
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.affiliation: InfraReDx Inc., Burlington, Massachusetts.
authors.forename: James E
authors.initials: JE
authors.lastname: Muller
authors.affiliation: Scottsdale Healthcare, Scottsdale, Arizona.
authors.forename: David G
authors.initials: DG
authors.lastname: Rizik
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Kendrick A
authors.initials: KA
authors.lastname: Shunk
authors.affiliation: Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York; The Cardiovascular Research Foundation, New York, New York.
authors.forename: Ori
authors.initials: O
authors.lastname: Ben-Yehuda
authors.affiliation: The Cardiovascular Research Foundation, New York, New York; Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Genereux
authors.affiliation: The Cardiovascular Research Foundation, New York, New York.
authors.forename: Ovidiu
authors.initials: O
authors.lastname: Dressler
authors.affiliation: The Cardiovascular Research Foundation, New York, New York.
authors.forename: Rupa
authors.initials: R
authors.lastname: Parvataneni
authors.affiliation: InfraReDx Inc., Burlington, Massachusetts.
authors.forename: Sean
authors.initials: S
authors.lastname: Madden
authors.affiliation: InfraReDx Inc., Burlington, Massachusetts.
authors.forename: Priti
authors.initials: P
authors.lastname: Shah
authors.affiliation: North Texas Veterans Affairs Medical Center, Dallas, Texas.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.affiliation: Mount Sinai Hospital, New York, New York.
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology*; D052279:Creatine Kinase, MB Form / Q000097:blood; D057505:Embolic Protection Devices; D005260:Female; D006801:Humans; D008055:Lipids / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D009336:Necrosis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation; D010865:Pilot Projects; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012422:Rupture, Spontaneous; D019265:Spectroscopy, Near-Infrared; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014481:United States
chemical_list: D015415:Biomarkers; D008055:Lipids; D052279:Creatine Kinase, MB Form
keywords: atherosclerosis; distal protection; embolization; myocardial infarction; near-infrared spectroscopy