The following is a summary of “Near-infrared spectroscopy-intravascular ultrasound to improve assessment of coronary artery disease severity in patients referred for transcatheter aortic valve implantation (The IMPACTavi registry): Design and rationale” published in the October 2023 issue of Heart Journal by Seguchi, et al.
Transcatheter aortic valve implantation (TAVI) became the normal way to treat people with serious aortic stenosis (AS) who are at high risk for surgery. Even though AS and coronary artery disease (CAD) often happen together, clinical and angiographic measurements of how bad the stenosis is can’t be relied on in this case. Near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS) were joined to give a more accurate risk classification of cardiac lesions. This method combines molecular and structural information on the makeup of plaque. However, there isn’t enough proof to show a link between NIRS-IVUS results like the highest 4mm lipid core burden index (maxLCBI4mm) and how well AS patients do after TAVI.
To get a better idea of how bad CAD is, this registry wants to find out if it is possible and safe to use NIRS-IVUS imaging during regular pre-TAVI coronary angiography. The registry is meant to be a prospective, observational, international group record that is not random. Patients who are sent for TAVI and have angiographic signs of CAD are given NIRS-IVUS imaging and are checked on for up to 24 months. The maxLCBI4mm of enrolled patients is divided into two groups: NIRS-IVUS positive and NIRS-IVUS negative. This lets them compare their clinical results.
Major unfavorable cardiovascular events over a 24-month follow-up time are the main goal of the register. An important unmet clinical need is determining which people are likely or unlikely to gain from angioplasty before TAVI. The goal of this collection is to find out if NIRS-IVUS-derived arterial plaque traits can be used to find patients and lesions that are more likely to have bad cardiovascular events after TAVI. This will help doctors make better decisions about how to treat this difficult group of patients.