Target Lesion Lipid Content Detected by Near-Infrared Spectroscopy After Stenting and the Risk of Subsequent Target Lesion Failure
Target Lesion Lipid Content Detected by Near-Infrared Spectroscopy After Stenting and the Risk of Subsequent Target Lesion Failure
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支架置入后近红外光谱检测靶病灶脂质含量及后续靶病灶失败的风险
DOI：
10.1161/atvbaha.120.315617
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Akasaka Takashi
中科院分区：
文献类型：
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作者：
Madder Ryan D.;Kubo Takashi;Ino Yasushi;Kameyama Takeyoshi;Terada Kosei;VanOosterhout Stacie;Mulder Abbey;McNamara Michael;Kenaan Mohamad;Samani Soroush;Kassier Adnan;Parker Jessica L.;McNamara Richard;Akasaka Takashi
经皮冠状动脉介入治疗（PCI）后，尚不清楚支架段中残留的脂质含量是否会增加靶病变失败（TLF）的风险。本研究评估了保留脂质含量在支架段检测后PCI冠状动脉内近红外光谱和TLF.Approach和ResultsAfter PCI的性能，PCI后近红外光谱血管内超声图像之间的关联被收购和分析由一个独立的核心实验室保留脂质含量在支架段，量化的最大脂质核心负担指数在4毫米（maxLCBI 4 mm）。主要结局是随访期间的TLF，定义为心血管死亡、靶血管心肌梗死和临床驱动的靶病变血运重建的复合终点。在202例接受PCI治疗并随访3.5±1.4年的209处靶病变患者中，基线PCI后近红外光谱血管内超声图像显示，随访期间有（297 [211，401]）TLF的最大LCBI 4 mm min支架病变显著高于无（119 [9，258]）TLF的最大LCBI 4 mm min支架病变（P=0.006）。通过多变量logistic回归分析，支架植入节段的最大LCBI 4 mm与随后的TLF独立相关（每增加100个单位，比值比为1.6 [95%CI，1.2-2.1]，P=0.004）。通过受试者操作特征分析，后续TLF的支架植入段的最佳残余maxLCBI 4 mm阈值为200。残余最大LCBI 4 mm>200的支架病变在随访期间的TLF显著高于最大LCBI 4 mm ≤200的支架病变（15.0%vs3.1%，P =0.002）。
ObjectiveAfter percutaneous coronary intervention (PCI), it is unknown whether retained lipid content in the stented segment increases the risk of target lesion failure (TLF). This study evaluated the association between retained lipid content in the stented segment detected by post-PCI intracoronary near-infrared spectroscopy and TLF.Approach and ResultsAfter the performance of PCI, post-PCI near-infrared spectroscopy–intravascular ultrasound images were acquired and analyzed by an independent core laboratory for retained lipid content in the stented segment, quantified by the maximum lipid core burden index in 4 mm (maxLCBI4mm). The primary outcome was TLF during follow-up, defined as a composite of cardiovascular death, target vessel myocardial infarction, and clinically driven target lesion revascularization. Among 202 patients with 209 target lesions treated by PCI and followed for 3.5±1.4 years, baseline post-PCI near-infrared spectroscopy–intravascular ultrasound images revealed a significantly greater maxLCBI4mmin stented lesions with (297 [211, 401]) versus without (119 [9, 258]) TLF during follow-up (P=0.006). By multivariate logistic regression, maxLCBI4mmin the stented segment was independently associated with subsequent TLF (odds ratio, 1.6 [95% CI, 1.2–2.1] for every 100-unit increase,P=0.004). By receiver-operating characteristic analysis, the optimal residual maxLCBI4mmthreshold in the stented segment for subsequent TLF was 200. Stented lesions with a residual maxLCBI4mm>200 had significantly greater TLF during follow-up than stented lesions with a maxLCBI4mm≤200 (15.0% versus 3.1%,P=0.002).ConclusionsRetained lipid content detected by near-infrared spectroscopy in the stented segment after PCI was associated with an increased risk of subsequent TLF.