The following is a summary of ‘’Clinical outcomes of acute myocardial infarction arising from non-lipid-rich plaque determined by NIRS-IVUS,” published in the July 2023 issue of Cardiology by Terada et al.
Non-lipid-rich coronary plaques rarely give rise to acute myocardial infarction (AMI). Researchers performed a retrospective study to compare clinical outcomes post-percutaneous coronary intervention (PCI) in AMI cases with (maxLCBI4mm) < 400 and ≥ 400 in infarct-related lesions assessed by near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS). They examined 426 AMI patients who received NIRS-IVUS assessment in infarct-related lesions prior to PCI.
Major adverse cardiovascular events (MACE) encompassed cardiac death, non-fatal MI, clinically driven target lesion revascularization (TLR), clinically driven non-TLR, and congestive heart failure necessitating hospitalization. Among the patients, 107 (25%) had infarct-related lesions with maxLCBI4mm < 400, while 319 (75%) had lesions with maxLCBI4mm ≥ 400. The maxLCBI4mm < 400 groups exhibited a younger median age at onset (68 years [IQR: 57–78 years] vs. 73 years [IQR: 64–80 years], P = 0.007), a lower occurrence of multivessel disease (39% vs. 51%, P = 0.029), a lower incidence of TIMI flow grade 0 or 1 before PCI (62% vs. 75%, P = 0.007), and a lower rate of no-reflow immediately after PCI (5% vs. 11%, P = 0.039). During a median follow-up period of 31 months [IQR: 19–48 months], the incidence of MACE was significantly lower in the maxLCBI4mm < 400 groups compared to the maxLCBI4mm ≥ 400 group (4.7% vs. 17.2%, P = 0.001). MaxLCBI4mm < 400 emerged as an independent predictor of MACE-free survival in multivariable analysis (hazard ratio: 0.36 [confidence interval: 0.13–0.98], P = 0.046).
Study concluded that maxLCBI4mm < 400, as measured by NIRS in infarct-related lesions before PCI, correlated with improved long-term clinical outcomes in patients with AMI.