title: Confirmation of the Intracoronary Near-Infrared Spectroscopy Threshold of Lipid-Rich Plaques That Underlie ST-Segment-Elevation Myocardial Infarction.
abstract: In a previous exploratory analysis, intracoronary near-infrared spectroscopy (NIRS) found the majority of culprit lesions in ST-segment-elevation myocardial infarction (STEMI) to contain a maximum lipid core burden index in 4 mm (maxLCBI4mm) of >400. This initial study was limited by a small sample size, enrollment at a single center, and post hoc selection of the maxLCBI4mm ≥400 threshold. This study was designed a priori to substantiate the ability of NIRS to discriminate STEMI culprit from nonculprit segments and to confirm the performance of the maxLCBI4mm ≥400 threshold.
  
  
  
  At 2 centers in the United States and Sweden, 75 STEMI patients underwent intracoronary NIRS imaging after establishing thrombolysis in myocardial infarction 3 flow, but before stenting. Blinded core laboratory analysis defined the culprit segment as the 10-mm segment distal to the proximal angiographic culprit margin. The remaining vessel was divided into contiguous 10-mm nonculprit segments. The maxLCBI4mm of culprit segments (median [interquartile range]: 543 [273-756]) was 4.4-fold greater than nonculprit segments (median [interquartile range]: 123 [0-307]; P<0.001). Receiver-operating characteristic analysis demonstrated that maxLCBI4mm differentiated culprit from nonculprit segments with high accuracy (c-statistic=0.83; P<0.001). A threshold maxLCBI4mm ≥400 identified STEMI culprit segments with a sensitivity of 64% and specificity of 85%.
  
  
  
  This study substantiates the ability of NIRS to accurately differentiate STEMI culprit from nonculprit segments and confirms that a threshold maxLCBI4mm ≥400 is detected by NIRS in the majority of STEMI culprits.
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia. ryan.madder@spectrumhealth.org.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Madder
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: James E
authors.initials: JE
authors.lastname: Muller
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: Jan
authors.initials: J
authors.lastname: Harnek
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: Matthias
authors.initials: M
authors.lastname: Götberg
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: Stacie
authors.initials: S
authors.lastname: VanOosterhout
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Chi
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Wohns
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: McNamara
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: Kathy
authors.initials: K
authors.lastname: Wolski
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Madden
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: Samuel
authors.initials: S
authors.lastname: Sidharta
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: Jordan
authors.initials: J
authors.lastname: Andrews
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
authors.affiliation: From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
mesh_terms: D000368:Aged; D019540:Area Under Curve; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008055:Lipids / Q000032:analysis*; D008297:Male; D008824:Michigan; D008875:Middle Aged; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D019265:Spectroscopy, Near-Infrared; D013548:Sweden; D018084:Ultrasonography, Interventional
chemical_list: D008055:Lipids
keywords: angiography; intravascular ultrasound; myocardial infarction; near-infrared spectroscopy; vulnerable plaque