Key result
Large lipid-rich plaque is linked to ~287% higher odds of an ACS culprit segment.
Why the study?
Asians have a much lower incidence of adverse coronary events than Caucasians, prompting evaluation of coronary lipid-rich plaque characteristics in Asian patients with ACS and stable angina, and identification of surrogate markers.
Does NIRS-IVUS plaque assessment differentiate culprit lesions in acute coronary syndrome versus stable angina in Japanese patients?
Observational (n=207)
No
Does NIRS-IVUS plaque assessment differentiate culprit lesions in acute coronary syndrome versus stable angina in Japanese patients?
NIRS-IVUS assessment demonstrates that acute coronary syndrome culprit lesions have significantly larger lipid-rich plaques compared to stable angina in Japanese patients, highlighting the value of direct intravascular imaging over systemic biomarkers.
Answers are grounded in this paper and cite their sources.
May aid NIRS-IVUS culprit identification in ACS; leaves open prospective outcome validation in Japanese patients.
Asians have a much lower incidence of adverse coronary events than Caucasians. We sought to evaluate the characteristics of coronary lipid-rich plaques (LRP) in Asian patients with acute coronary syndrome (ACS) and stable angina (SA). We also aimed to identify surrogate markers for the extent of LRP. We evaluated 207 patients (ACS, n = 75; SA, n = 132) who underwent percutaneous coronary intervention under near infrared spectroscopy intravascular ultrasound (NIRS-IVUS). Plaque characteristics and the extent of LRP [defined as a long segment with a 4-mm maximum lipid-core burden index (maxLCBI4mm)] on NIRS in de-novo culprit and non-culprit segments were analyzed. The ACS culprit lesions had a significantly higher maxLCBI4mm (median [interquartile range (IQR)]: 533 [385–745] vs. 361 [174–527], p < 0.001) than the SA culprit lesions. On multivariate logistic analysis, a large LRP (defined as maxLCBI4mm ≥ 400) was the strongest independent predictor of the ACS culprit segment (odds ratio, 3.87; 95% confidence interval, 1.95–8.02). In non-culprit segments, 19.8% of patients had at least one large LRP without a small lumen. No significant correlation was found between the extent of LRP and systematic biomarkers (hs-CRP, IL-6, TNF-α), whereas the extent of LRP was positively correlated with IVUS plaque burden (r = 0.24, p < 0.001). We confirmed that NIRS-IVUS plaque assessment could be useful to differentiate ACS from SA culprit lesions, and that a threshold maxLCBI4mm ≥ 400 was clinically suitable in Japanese patients. No surrogate maker for a high-risk LRP was found; consequently, direct intravascular evaluation of plaque characteristics remains important.
No takes yet. Share an insight, caveat, or question.
Takahashi et al. (2021) conducted an observational in Acute coronary syndrome and stable angina (n=207). Acute coronary syndrome (ACS) vs. Stable angina (SA) was evaluated on ACS culprit segment prediction by maxLCBI 4mm ≥400 (OR 3.87, 95% CI 1.95-8.02, p=<0.001). A large lipid-rich plaque, defined as maxLCBI 4mm ≥400, was the strongest independent predictor of an acute coronary syndrome culprit segment compared to stable angina.
Synapse has enriched 8 closely related papers on similar clinical questions. Consider them for comparative context: