In Vivo Relationship Between Near-Infrared Spectroscony-Detected Lipid-Rich Plaques And Morphological Plaque Characteristics By Optical Coherence Tomography And Intravascular Ultrasound: A Multimodality Intravascular Imaging Study

Aims We assessed morphological features of near-infrared spectroscopy (NIRS)-detected lipid-rich plaques (LRPs) by using optical coherence tomography (OCT) and intravascular ultrasound (IVUS).Methods and results IVUS-NIRS and OCT were performed in the two non-infarct-related arteries (non-IRAs) in patients undergoing percutaneous coronary intervention for treatment of an acute coronary syndrome. A lesion was defined as the 4 mm segment with the maximum amount of lipid core burden index (maxLCBI(4mm)) of each LRP detected by NIRS. We divided the lesions into three groups based on the maxLCBI(4mm) value: <250, 250-399, and >= 400. OCT analysis and IVUS analysis were performed blinded for NIRS. We measured fibrous cap thickness (FCT) by using a semi-automated method. A total of 104 patients underwent multimodality imaging of 209 non-IRAs. NIRS detected 299 LRPs. Of those, 41% showed a maxLCBI(4mm) <250, 39% a maxLCBI(4mm) 251-399, and 19% a maxLCBI(4mm) >= 400. LRPs with a maxLCBI(4mm) >= 400, as compared with LRPs with amaxLCBI(4mm) 250-399 and <250, were more frequently thin-cap fibroatheroma (TCFA) (42.1% vs. 5.1% and 0.8%; P< 0.001) with a smaller minimum FCT (80 mu m vs. 110 mu m and 120 mu m; P< 0.001); a higher IVUS-derived percent atheroma volume (53% vs. 53% and 44%; P<0.001) and a higher remodelling index (1.08 vs. 1.02 and 1.01; P<0.001). MaxLCBI(4mm) correlated with OCT-derived FCT (r= 0.404; P<0.001) and was the best predictor for TCFA with an optimal cut-off value of 401 (area under the curve = 0.882; P< 0.001).Conclusion LRPs with increasing maxLCBI(4mm) exhibit OCT and IVUS features of presumed plaque vulnerability including TCFA morphology, increased plaque burden, and positive remodelling.