Near-infrared spectroscopy to predict microvascular obstruction after primary percutaneous coronary intervention
Near-infrared spectroscopy to predict microvascular obstruction after primary percutaneous coronary intervention
复制标题
DOI：
10.4244/eij-d-20-01421
复制
发表时间：
2021-12-01
期刊：
影响因子：
6.2
通讯作者：
Akasaka, Takashi
中科院分区：
文献类型：
--
作者：
Terada, Kosei;Kubo, Takashi;Akasaka, Takashi
背景：st段抬高型心肌梗死（STEMI）经皮冠状动脉介入治疗（PPCI）成功恢复心外膜冠状动脉通畅并不总是导致微血管水平足够的再灌注。目的：本研究旨在探讨近红外光谱联合血管内超声（NIRS-IVUS）鉴定的富含脂质冠状动脉斑块与心脏磁共振成像（MRI）检测的STEMI PPCI后微血管阻塞（MVO）之间的关系。方法：对120例STEMI患者行PPCI治疗。应用NIRS-IVUS测定PPCI前梗死相关病变4mm内最大脂质核心负荷指数（maxlcbi4mm）。PPCI后一周进行延迟对比增强心脏MRI评估MVO。结果：40例（33%）患者出现MVO。与无MVO组相比，MVO组梗死相关病变的maxlcbi4mm显著增大（中位数[四分位数范围]:745 [522-853]vs 515 [349-698]， p 0.001）。多变量logistic回归模型显示，maxLCBI4 mm是MVO的独立预测因子（优势比：24.7[95%置信区间：2.5 ~ 248.0],p=0.006）。受试者工作特征曲线分析表明，maxLCBI4 mm 600是预测MVO的最佳临界值（约登指数=0.44，曲线下面积=0.71），敏感性为75%，特异性为69%。结论：近红外光谱测量梗死相关病变的脂质含量与STEMI PPCI后MVO的发生有关。
Background: Successful restoration of epicardial coronary artery patency by primary percutaneous coro-nary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) does not always lead to adequate reperfusion at the microvascular level. Aims: This study sought to investigate the association between lipid-rich coronary plaque identified by near-infrared spectroscopy combined with intravascular ultrasound (NIRS-IVUS) and microvascular obstruction (MVO) detected by cardiac magnetic resonance imaging (MRI) after PPCI for STEMI. Methods: We investigated 120 patients with STEMI undergoing PPCI. NIRS-IVUS was used to measure the maximum lipid core burden index in 4 mm (maxLCBI4 mm) in the infarct-related lesions before PPCI. Delayed contrast-enhanced cardiac MRI was performed to evaluate MVO one week after PPCI. Results: MVO was identified in 40 (33%) patients. MaxLCBI4 mm in the infarct-related lesion was signif-icantly larger in the MVO group compared with the no-MVO group (median [interquartile range]: 745 [522-853] vs 515 [349-698], p 0.001). A multivariable logistic regression model showed that maxLCBI4 mm was an independent predictor of MVO (odds ratio: 24.7 [95% confidence interval: 2.5-248.0], p=0.006). Receiver operating characteristic curve analysis demonstrated that maxLCBI4 mm 600 was the optimal cut-off value to predict MVO (Youden index=0.44 and area under the curve=0.71) with a sensitivity of 75% and a specificity of 69%. Conclusions: Lipid content measured by NIRS in the infarct-related lesions was associated with the occur-rence of MVO after PPCI in STEMI.