title: Large lipid-rich coronary plaques detected by near-infrared spectroscopy at non-stented sites in the target artery identify patients likely to experience future major adverse cardiovascular events.
abstract: OBJECTIVE
  A recent study demonstrated that intracoronary near-infrared spectroscopy (NIRS) findings in non-target vessels are associated with major adverse cardiovascular and cerebrovascular events (MACCE). It is unknown whether NIRS findings at non-stented sites in target vessels are similarly associated with future MACCE. This study evaluated the association between large lipid-rich plaques (LRP) detected by NIRS at non-stented sites in a target artery and subsequent MACCE.
  
  
  RESULTS
  This study evaluated 121 consecutive registry patients undergoing NIRS imaging in a target artery. After excluding stented segments, target arteries were evaluated for a large LRP, defined as a maximum lipid core burden index in 4 mm (maxLCBI4 mm) ≥400. Excluding events in stented segments, Cox regression analysis was performed to evaluate for an association between a maxLCBI4 mm ≥400 and future MACCE, defined as all-cause mortality, non-fatal acute coronary syndrome, and cerebrovascular events. NIRS detected a maxLCBI4 mm ≥400 in a non-stented segment of the target artery in 17.4% of patients. The only baseline clinical variable marginally associated with MACCE was ejection fraction (HR 0.96, 95% CI 0.93-1.00, P = 0.054). A maxLCBI4 mm ≥400 in a non-stented segment at baseline was significantly associated with MACCE during follow-up (HR 10.2, 95% CI 3.4-30.6, P < 0.001).
  
  
  CONCLUSIONS
  Detection of large LRP by NIRS at non-stented sites in a target artery was associated with an increased risk of future MACCE. These findings support ongoing prospective studies to further evaluate the ability of NIRS to identify vulnerable patients.
authors.affiliation: Frederik Meijer Heart and Vascular Institute, Spectrum Health, 100 Michigan Street NE, Grand Rapids, MI 49503, USA ryan.madder@spectrumhealth.org.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Madder
authors.affiliation: Frederik Meijer Heart and Vascular Institute, Spectrum Health, 100 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Husaini
authors.affiliation: Department of Surgery, Michigan State University and Research Department, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.affiliation: Frederik Meijer Heart and Vascular Institute, Spectrum Health, 100 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: Stacie
authors.initials: S
authors.lastname: VanOosterhout
authors.affiliation: Frederik Meijer Heart and Vascular Institute, Spectrum Health, 100 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: Mohsin
authors.initials: M
authors.lastname: Khan
authors.affiliation: Frederik Meijer Heart and Vascular Institute, Spectrum Health, 100 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: David
authors.initials: D
authors.lastname: Wohns
authors.affiliation: Frederik Meijer Heart and Vascular Institute, Spectrum Health, 100 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: Richard F
authors.initials: RF
authors.lastname: McNamara
authors.affiliation: Frederik Meijer Heart and Vascular Institute, Spectrum Health, 100 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Wolschleger
authors.affiliation: Frederik Meijer Heart and Vascular Institute, Spectrum Health, 100 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: John
authors.initials: J
authors.lastname: Gribar
authors.affiliation: Frederik Meijer Heart and Vascular Institute, Spectrum Health, 100 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: J Stewart
authors.initials: JS
authors.lastname: Collins
authors.affiliation: Frederik Meijer Heart and Vascular Institute, Spectrum Health, 100 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Jacoby
authors.affiliation: Frederik Meijer Heart and Vascular Institute, Spectrum Health, 100 Michigan Street NE, Grand Rapids, MI 49503, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Decker
authors.affiliation: Infraredx, Inc., Burlington, MA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hendricks
authors.affiliation: Infraredx, Inc., Burlington, MA, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Sum
authors.affiliation: Infraredx, Inc., Burlington, MA, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Madden
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Ware
authors.affiliation: Infraredx, Inc., Burlington, MA, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Muller
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared / Q000379:methods*
keywords: lipid-rich plaque; near-infrared spectroscopy; vulnerable patient