Madder Ryan D, Puri Rishi, Muller James E, Harnek Jan, Götberg Matthias, VanOosterhout Stacie, Chi Margaret, Wohns David, McNamara Richard, Wolski Kathy, Madden Sean, Sidharta Samuel, Andrews Jordan, Nicholls Stephen J, Erlinge David
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.
Arterioscler Thromb Vasc Biol. 2016 May;36(5):1010-5. doi: 10.1161/ATVBAHA.115.306849. Epub 2016 Mar 3.
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.
在先前的一项探索性分析中，冠状动脉内近红外光谱（NIRS）发现，ST段抬高型心肌梗死（STEMI）中的大多数罪犯病变在4毫米范围内的最大脂质核心负担指数（maxLCBI4mm）>400。这项初步研究存在样本量小、仅在单一中心入组以及事后选择maxLCBI4mm≥400阈值的局限性。本研究进行了预先设计，以证实NIRS区分STEMI罪犯节段与非罪犯节段的能力，并确认maxLCBI4mm≥400阈值的性能。
在美国和瑞典的2个中心，75例STEMI患者在实现心肌梗死溶栓3级血流后、支架置入前接受了冠状动脉内NIRS成像。由盲法核心实验室分析将罪犯节段定义为血管造影显示的罪犯边缘近端远端的10毫米节段。其余血管被分成连续的10毫米非罪犯节段。罪犯节段的maxLCBI4mm（中位数[四分位间距]：543[273 - 756]）比非罪犯节段（中位数[四分位间距]：123[0 - 307]）大4.4倍（P<0.001）。受试者操作特征分析表明，maxLCBI4mm能够以高准确度区分罪犯节段与非罪犯节段（c统计量 = 0.83；P<0.001）。maxLCBI4mm≥400的阈值识别STEMI罪犯节段的灵敏度为64%，特异度为85%。
本研究证实了NIRS准确区分STEMI罪犯节段与非罪犯节段的能力，并确认NIRS在大多数STEMI罪犯病变中检测到maxLCBI4mm≥400的阈值。
