Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
JACC Cardiovasc Interv. 2015 Jun;8(7):937-45. doi: 10.1016/j.jcin.2015.03.016.
The aim of this study is to compare the relative merits of optical coherence tomography (OCT), intravascular ultrasound (IVUS), and near infrared spectroscopy (NIRS) in patients with coronary artery disease for the prediction of periprocedural myocardial infarction (MI).
Although several individual intravascular imaging modalities have been employed to predict periprocedural MI, it is unclear which of the imaging tools would best allow prediction of this complication.
We retrospectively analyzed 110 patients who underwent OCT, IVUS, and NIRS. Periprocedural MI was defined as a post-procedural cardiac troponin I (cTnI) elevation above 3× the upper limit of normal; analysis was also performed for cTnI ≥5× the upper limit of normal.
cTnI ≥3× was observed in 10 patients (9%) and 8 patients had cTnI ≥5×. By OCT, minimum cap thickness was significantly lower (55 vs. 90 μm, p < 0.01), and the plaque burden by IVUS (84 ± 9% vs. 77 ± 8%, p < 0.01) and maximum 4-mm lipid core burden index by NIRS (556 vs. 339, p < 0.01) were greater in the cTnI ≥3× group. Multivariate logistic regression analysis identified cap thickness as the only independent predictor for cTnI ≥3× the upper limit of normal (odds ratio [OR]: 0.90, p = 0.02) or cTnI ≥5× (OR: 0.91, p = 0.04). If OCT findings were excluded from the analysis, plaque burden (OR: 1.13, p = 0.045) and maximum 4-mm lipid core burden index (OR: 1.003, p = 0.037) emerged to be the independent predictors.
OCT-based fibrous cap thickness is the most important predictor of periprocedural MI. In the absence of information about cap thickness, NIRS lipid core or IVUS plaque burden best determined the likelihood of the periprocedural event.
本研究旨在比较光学相干断层扫描（OCT）、血管内超声（IVUS）和近红外光谱（NIRS）在预测冠状动脉疾病患者围手术期心肌梗死（MI）方面的相对优势。
尽管已经使用了几种单独的血管内成像方式来预测围手术期 MI，但尚不清楚哪种成像工具最能预测这种并发症。
我们回顾性分析了 110 例接受 OCT、IVUS 和 NIRS 检查的患者。围手术期 MI 定义为术后心脏肌钙蛋白 I（cTnI）升高超过正常值上限的 3 倍；也对 cTnI 升高超过正常值上限的 5 倍进行了分析。
10 例患者（9%）出现 cTnI 升高超过 3 倍，8 例患者出现 cTnI 升高超过 5 倍。OCT 显示最小帽厚度明显较低（55 与 90μm，p<0.01），IVUS 显示斑块负荷（84±9%与 77±8%，p<0.01）和 NIRS 显示最大 4mm 脂质核心负荷指数（556 与 339，p<0.01）在 cTnI 升高超过 3 倍的患者中更高。多变量逻辑回归分析表明，帽厚度是 cTnI 升高超过正常值上限 3 倍（比值比[OR]：0.90，p=0.02）或 cTnI 升高超过 5 倍（OR：0.91，p=0.04）的唯一独立预测因素。如果将 OCT 结果从分析中排除，斑块负荷（OR：1.13，p=0.045）和最大 4mm 脂质核心负荷指数（OR：1.003，p=0.037）则成为独立预测因素。
基于 OCT 的纤维帽厚度是预测围手术期 MI 的最重要指标。在缺乏帽厚度信息的情况下，NIRS 脂质核心或 IVUS 斑块负荷最能确定围手术期事件的可能性。
