Korean Circ J.  2019 Nov;49(11):1010-1018. 10.4070/kcj.2019.0072.

Lipid-Core Plaque Assessed by Near-Infrared Spectroscopy and Procedure Related Microvascular Injury

• Yang HM
• Yoon MH
• Lim HS
• Seo KW
• Choi BJ
• Choi SY
• Hwang GS
• Tahk SJ

• KMID: 2460525
• DOI: http://doi.org/10.4070/kcj.2019.0072

Abstract

BACKGROUND AND OBJECTIVES
Microvascular damage due to distal embolization during percutaneous coronary intervention (PCI) is an important cause of periprocedural myocardial infarction. We assessed the lipid-core plaque using near-infrared spectroscopy (NIRS) and microvascular dysfunction invasively with the index of microcirculatory resistance (IMR) and evaluated their relationship.
METHODS
This study is pilot retrospective observational study. We analyzed 39 patients who performed NIRS before and after PCI, while fractional flow reserve, thermo-dilution coronary flow reserve (CFR) and IMR were measured after PCI. The maximum value of lipid core burden index (LCBI) for any of the 4-mm segments at the culprit lesion (culprit LCBI(4mm)) was calculated at the culprit lesion. We divided the patients into 2 groups using a cutoff of culprit LCBI(4mm) ≥500.
RESULTS
Mean pre-PCI LCBI was 333±196 and mean post-PCI IMR was 20±14 U. Post-PCI IMR was higher (15.6±7.3 vs. 42.6±17.6 U, p<0.001) and post-PCI CFR was lower (3.7±2.2 vs. 2.1±1.0, p=0.029) in the high LCBI group. Pre-PCI LCBI was positively correlated with post-PCI IMR (ρ=0.358, p=0.025) and negatively correlated with post-PCI CFR (ρ=−0.494, p=0.001). The incidence of microvascular dysfunction (IMR ≥25 U) was higher in the high LCBI group (9.4% vs. 85.7%, p<0.001). However, there were no significant differences in the incidences of creatine Kinase-MB (9.4% vs. 14.3%, p=0.563) and troponin-I elevation (12.5% vs. 14.3%, p=1.000).
CONCLUSIONS
A large lipid-core plaque at the "˜culprit' lesion is observed higher incidence of post-PCI microvascular dysfunction after PCI. Prospective study with adequate subject numbers will be needed.

Keyword

Percutaneous coronary intervention; Coronary artery disease; Microvessel; Near-infrared spectroscopy

MeSH Terms

Coronary Artery Disease
Creatine
Humans
Incidence
Microvessels
Myocardial Infarction
Observational Study
Percutaneous Coronary Intervention
Prospective Studies
Retrospective Studies
Spectroscopy, Near-Infrared*
Troponin I
Creatine
Troponin I

Figure

• 

  Figure 1 Comparison of physiologic parameters. The mean value of post-PCI IMR was higher (15.6±7.3 vs. 42.6±17.6 U, p<0.001) and post-PCI CFR was lower in high LCBI group (3.7±2.2 vs. 2.1±1.0, p=0.029). CFR = coronary flow reserve; IMR = index of microcirculatory resistance; LCBI = culprit lipid-core burden index; PCI = percutaneous coronary intervention.

• 

  Figure 2 Correlation between pre-intervention LCBI and physiologic parameters. CFR = coronary flow reserve; IMR = index of microcirculatory resistance; LCBI = culprit lipid-core burden index; PCI = percutaneous coronary intervention.

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