美国梅德斯达华盛顿医院中心Ron Waksman小组在最新研究中，探讨建立近红外光谱（NIRS）血管内超声成像检测斑块与未来冠状动脉事件之间的关系。2019年9月27日，《柳叶刀》在线发表了这一成果。

 

NIRS血管内超声成像可检测富脂斑块（LRPs）。LRPs与急性冠状动脉综合征或心肌梗死相关，可导致血管重建或心脏死亡。

 

研究组在意大利、拉脱维亚、荷兰、斯洛伐克、英国和美国的44个医疗中心进行了这项前瞻性队列研究。招募疑似冠心病且进行过心脏导管插入术，并可能施行了经皮冠状动脉介入治疗的患者。参与者均接受NIRS血管内超声扫描非罪犯节段。

 

2014年2月21日至2016年3月30日，研究组共招募了1563名参与者。共发生NIRS血管内超声设备相关事件6例（0.4%）。1271名患者接受了随访，平均年龄64岁，69%为男性，31%为女性。非罪犯节段重大心血管不良事件（NC-MACE）的2年累积发病率为9%（n=103）。

 

在患者水平上，NC-MACE的未校正风险比为1.21，每增加100个单位最大LCBI 4mm，校正风险比为1.18。对于最大LCBI 4mm大于400的患者，NC-MACE的未校正风险比为2.18，校正风险比为1.89。在斑块水平上，最大LCBI 4mm每增加100个单位，未校正风险比为1.45。对于最大LCBI 4mm大于400的节段，NC-MACE的未校正风险比为4.22，校正风险比为3.39。

 

总之，对于接受心脏导管插入术和可能的经皮冠状动脉介入治疗的患者，对非梗阻区域进行NIRS成像是安全的，并且有助于识别NC-MACE风险较高的患者和节段。NIRS血管内超声成像作为临床上第一个能够检测出易感患者和斑块的诊断工具，值得临床推广。

附：英文原文

Title: Identification of patients and plaques vulnerable to future coronary events with near-infrared spectroscopy intravascular ultrasound imaging: a prospective, cohort study

Author: Prof Ron Waksman, MD,Prof Carlo Di Mario, MD,Rebecca Torguson, MPH,Prof Ziad A Ali, MD,Prof Varinder Singh, MD,William H Skinner, MD,Prof Andre K Artis, MD,Tim Ten Cate, MD,Prof Eric Powers, MD,Christopher Kim, MD,Prof Evelyn Regar, MD,Prof S Chiu Wong, MD,Stephen Lewis, MD,Joanna Wykrzykowska, MD,Sandeep Dube, MD,Prof Samer Kazziha, MD,Martin van der Ent, MD,Priti Shah, MS,Paige E Craig, MPH,Quan Zou, PhD,Paul Kolm, PhD,H Bryan Brewer, MD,Prof Hector M Garcia-Garcia, MD,on behalf of the LRP Investigators †

Issue&Volume: 2019/09/27

Summary: 

Background

Near-infrared spectroscopy (NIRS) intravascular ultrasound imaging can detect lipid-rich plaques (LRPs). LRPs are associated with acute coronary syndromes or myocardial infarction, which can result in revascularisation or cardiac death. In this study, we aimed to establish the relationship between LRPs detected by NIRS-intravascular ultrasound imaging at unstented sites and subsequent coronary events from new culprit lesions.

Methods

In this prospective, cohort study (LRP), patients from 44 medical centres were enrolled in Italy, Latvia, Netherlands, Slovakia, UK, and the USA. Patients with suspected coronary artery disease who underwent cardiac catheterisation with possible ad hoc percutaneous coronary intervention were eligible to be enrolled. Enrolled patients underwent scanning of non-culprit segments using NIRS-intravascular ultrasound imaging. The study had two hierarchal primary hypotheses, patient and plaque, each testing the association between maximum 4 mm Lipid Core Burden Index (maxLCBI 4mm) and non-culprit major adverse cardiovascular events (NC-MACE). Enrolled patients with large LRPs (≥250 maxLCBI 4mm) and a randomly selected half of patients with small LRPs (<250 maxLCBI 4mm) were followed up for 24 months. This study is registered with ClinicalTrials.gov, NCT02033694.

Findings

Between Feb 21, 2014, and March 30, 2016, 1563 patients were enrolled. NIRS-intravascular ultrasound device-related events were seen in six (0·4%) patients. 1271 patients (mean age 64 years, SD 10, 883 [69%] men, 388 [31%]women) with analysable maxLCBI 4mm were allocated to follow-up. The 2-year cumulative incidence of NC-MACE was 9% (n=103). Both hierarchical primary hypotheses were met. On a patient level, the unadjusted hazard ratio (HR) for NC-MACE was 1·21 (95% CI 1·09–1·35; p=0·0004) for each 100-unit increase maxLCBI 4mm) and adjusted HR 1·18 (1·05–1·32; p=0·0043). In patients with a maxLCBI 4mm more than 400, the unadjusted HR for NC-MACE was 2·18 (1·48–3·22; p<0·0001) and adjusted HR was 1·89 (1·26–2·83; p=0·0021). At the plaque level, the unadjusted HR was 1·45 (1·30–1·60; p<0·0001) for each 100-unit increase in maxLCBI 4mm. For segments with a maxLCBI 4mm more than 400, the unadjusted HR for NC-MACE was 4·22 (2·39–7·45; p<0·0001) and adjusted HR was 3·39 (1·85–6·20; p<0·0001).

Interpretation

NIRS imaging of non-obstructive territories in patients undergoing cardiac catheterisation and possible percutaneous coronary intervention was safe and can aid in identifying patients and segments at higher risk for subsequent NC-MACE. NIRS-intravascular ultrasound imaging adds to the armamentarium as the first diagnostic tool able to detect vulnerable patients and plaques in clinical practice.

DOI: 10.1016/S0140-6736(19)31794-5

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31794-5/fulltext