Department of Cardiovascular Medicine, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA.
Circ Cardiovasc Interv. 2011 Oct 1;4(5):429-37. doi: 10.1161/CIRCINTERVENTIONS.111.963264. Epub 2011 Oct 4.
Percutaneous coronary intervention (PCI) is associated with periprocedural myocardial infarction (MI) in 3% to 15% of cases (depending on the definition used). In many cases, these MIs result from distal embolization of lipid-core plaque (LCP) constituents. Prospective identification of LCP with catheter-based near-infrared spectroscopy (NIRS) may predict an increased risk of periprocedural MI and facilitate development of preventive measures.
The present study analyzed the relationship between the presence of a large LCP (detected by NIRS) and periprocedural MI. Patients with stable preprocedural cardiac biomarkers undergoing stenting were identified from the COLOR Registry, an ongoing prospective observational study of patients undergoing NIRS before PCI. The extent of LCP in the treatment zone was calculated as the maximal lipid-core burden index (LCBI) measured by NIRS for each of the 4-mm longitudinal segments in the treatment zone. A periprocedural MI was defined as new cardiac biomarker elevation above 3× upper limit of normal. A total of 62 patients undergoing stenting met eligibility criteria. A large LCP (defined as a maxLCBI(4 mm) ≥500) was present in 14 of 62 lesions (22.6%), and periprocedural MI was documented in 9 of 62 (14.5%) of cases. Periprocedural MI occurred in 7 of 14 patients (50%) with a maxLCBI(4 mm) ≥500, compared with 2 of 48 patients (4.2%) patients with a lower maxLCBI(4 mm) (P=0.0002).
NIRS provides rapid, automated detection of extensive LCPs that are associated with a high risk of periprocedural MI, presumably due to embolization of plaque contents during coronary intervention.
经皮冠状动脉介入治疗（PCI）与围手术期心肌梗死（MI）相关，发生率为 3%至 15%（取决于使用的定义）。在许多情况下，这些 MI 是由脂质核心斑块（LCP）成分的远端栓塞引起的。基于导管的近红外光谱（NIRS）对 LCP 的前瞻性识别可能预测围手术期 MI 的风险增加，并有助于制定预防措施。
本研究分析了存在大的 LCP（通过 NIRS 检测到）与围手术期 MI 之间的关系。从 COLOR 登记处确定了接受支架置入术的稳定术前心脏生物标志物患者，该登记处是一项正在进行的前瞻性观察性研究，在 PCI 前对患者进行 NIRS 检查。治疗区 LCP 的程度通过治疗区每个 4mm 纵向节段的 NIRS 测量的最大脂质核心负担指数（LCBI）计算。围手术期 MI 定义为新的心脏生物标志物升高超过正常上限的 3 倍。共有 62 名接受支架置入术的患者符合入选标准。62 个病变中有 14 个（22.6%）存在大的 LCP（定义为 maxLCBI（4mm）≥500），62 个病例中有 9 个（14.5%）发生围手术期 MI。maxLCBI（4mm）≥500 的 14 名患者中有 7 名（50%）发生围手术期 MI，而 maxLCBI（4mm）较低的 48 名患者中有 2 名（4.2%）发生围手术期 MI（P=0.0002）。
NIRS 提供了快速、自动的检测广泛的 LCP，这与围手术期 MI 的高风险相关，推测是由于冠状动脉介入治疗期间斑块内容物的栓塞。
