Identification of vulnerable plaques and patients by intracoronary near-infrared spectroscopy and ultrasound (PROSPECT II): a prospective natural history study
Identification of vulnerable plaques and patients by intracoronary near-infrared spectroscopy and ultrasound (PROSPECT II): a prospective natural history study
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DOI：
10.1016/s0140-6736(21)00249-x
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发表时间：
2021-03-13
期刊：
影响因子：
168.9
通讯作者：
Stone, Gregg W.
中科院分区：
文献类型：
--
作者：
Erlinge, David;Maehara, Akiko;Stone, Gregg W.
背景近红外光谱(NIRS)和血管内超声是识别可能导致冠状动脉相关事件的非梗阻性斑块的最有前途的成像手段。我们的目的是评估联合使用NIRS和血管内超声是否可以识别高危斑块和面临未来重大不良心脏事件(MACEs)风险的患者。方法PROSPECT II是一项由研究人员赞助的多中心前瞻性自然历史研究，在丹麦、挪威和瑞典的14所大学医院和两家社区医院进行。我们招募了最近(过去4周内)有心肌梗死的任何年龄的患者。治疗完所有血流受限的冠状动脉病变后，使用NIRS和血管内超声导管进行三支血管成像。未经治疗的病变(也称为非罪魁祸首病变)通过血管内超声进行识别，并通过近红外光谱(NIRS)评估其脂质含量。主要结果是在随访期间未经治疗的非罪魁祸首病变引起的MACEs(心源性死亡、心肌梗死、不稳定型心绞痛或进展性心绞痛)的协变量调整率。确定高脂含量斑块、斑块负荷大、管腔面积小的斑块与患者水平和病变水平事件的关系。这项试验在ClinicalTrials.gov，NCT02171065注册。在2014年6月10日至2017年12月20日期间，898名患者中有3629个非肇事者病变(女性153[17%]女性，男性745[83%]；中位年龄63[IQR 55-70]岁)。中位随访期为3.7(IQR 3.0~4.4)年。在898例患者中，112例(13.2%，95%可信区间11.0~15.6)在4年内发生不良事件，其中66例(8.0%，95%可信区间6.2~10.0)来自78个未经治疗的非罪魁祸首病变(平均基线血管造影直径狭窄46.9%[SD 15.9])。高脂病变(3500个病变中的851个[24%]，884名患者中的520个[59%])是患者水平的非罪魁性病变相关斑块(调整后的优势比为2.27，95%可信区间为1.25-4.13)和非罪魁性病变特异性斑块(7.83，4.12-14.89)的独立预测因子。大斑块负荷(3629个病变中的787个[22%]，898名患者中的530个[59%])也是非罪魁祸首病变相关斑块的独立预测因子。血管内超声显示的大斑块负荷和NIRS显示的大富脂斑块的4年非罪魁祸首病变相关MACE发生率为7.0%(95%可信区间4.0~10.0)。在发现一个或多个此类病变的患者中，4年非罪魁祸首病变相关MACE率为13.2%(95%可信区间9.4-17.6)。解释结合NIRS和血管内超声检测到血管造影术中高脂含量和大斑块负荷的非梗阻性病变，这些病变未来不良心脏结局的风险增加。版权所有(C)2021爱思唯尔有限公司。保留所有权利。
Background Near-infrared spectroscopy (NIRS) and intravascular ultrasound are promising imaging modalities to identify non-obstructive plaques likely to cause coronary-related events. We aimed to assess whether combined NIRS and intravascular ultrasound can identify high-risk plaques and patients that are at risk for future major adverse cardiac events (MACEs).Methods PROSPECT II is an investigator-sponsored, multicentre, prospective natural history study done at 14 university hospitals and two community hospitals in Denmark, Norway, and Sweden. We recruited patients of any age with recent (within past 4 weeks) myocardial infarction. After treatment of all flow-limiting coronary lesions, three-vessel imaging was done with a combined NIRS and intravascular ultrasound catheter. Untreated lesions (also known as non-culprit lesions) were identified by intravascular ultrasound and their lipid content was assessed by NIRS. The primary outcome was the covariate-adjusted rate of MACEs (the composite of cardiac death, myocardial infarction, unstable angina, or progressive angina) arising from untreated non-culprit lesions during follow-up. The relations between plaques with high lipid content, large plaque burden, and small lumen areas and patient-level and lesion-level events were determined. This trial is registered with ClinicalTrials.gov, NCT02171065.Findings Between June 10, 2014, and Dec 20, 2017, 3629 non-culprit lesions were characterised in 898 patients (153 [17%] women, 745 [83%] men; median age 63 [IQR 55-70] years). Median follow-up was 3.7 (IQR 3.0-4.4) years. Adverse events within 4 years occurred in 112 (13.2%, 95% CI 11.0-15.6) of 898 patients, with 66 (8.0%, 95% CI 6.2-10.0) arising from 78 untreated non-culprit lesions (mean baseline angiographic diameter stenosis 46.9% [SD 15.9]). Highly lipidic lesions (851 [24%] of 3500 lesions, present in 520 [59%] of 884 patients) were an independent predictor of patient-level non-culprit lesion-related MACEs (adjusted odds ratio 2.27, 95% CI 1.25-4.13) and nonculprit lesion-specific MACEs (7.83, 4.12-14.89). Large plaque burden (787 [22%] of 3629 lesions, present in 530 [59%] of 898 patients) was also an independent predictor of non-culprit lesion-related MACEs. Lesions with both large plaque burden by intravascular ultrasound and large lipid-rich cores by NIRS had a 4-year non-culprit lesion-related MACE rate of 7.0% (95% CI 4.0-10.0). Patients in whom one or more such lesions were identified had a 4-year non-culprit lesion-related MACE rate of 13.2% (95% CI 9.4-17.6).Interpretation Combined NIRS and intravascular ultrasound detects angiographically non-obstructive lesions with a high lipid content and large plaque burden that are at increased risk for future adverse cardiac outcomes. Copyright (C) 2021 Elsevier Ltd. All rights reserved.