Author + information
- Zaahir Turfe1,
- Mustafa Husaini1,
- Margaret Chi1,
- Andrew Schmale1,
- Sarah Dionne1,
- Stacie Vanoosterhout2 and
- Ryan D. Madder2
We sought to describe the intracoronary near-infrared spectroscopy (NIRS) findings in survivors of sudden cardiac arrest.
Sudden cardiac death remains a major public health problem. Autopsy studies have established that sudden death is often attributable to rupture of an intracoronary lipid core plaque (LCP) with subsequent thrombosis. Similar observations linking LCP to sudden cardiac death have not been firmly established in vivo.
We studied five consecutive patients who presented with a sudden cardiac arrest, were successfully resuscitated, had a culprit lesion thought to be responsible for the cardiac arrest, and who underwent combined NIRS and intravascular ultrasound (IVUS) imaging prior to stent placement. To quantify the amount of lipid present by NIRS, we scanned each culprit and non-culprit segment for the maximum lipid core burden index in any 4-mm region (maxLCBI4mm).
NIRS-IVUS identified the presence of a large lipid core plaque within the culprit segment of all five sudden cardiac arrest victims. The maxLCBI4mm of the culprit segment was 604 ± 174 and the culprit lesion was characterized by a maxLCBI4mm >400 in all 5 cases. In contrast, of the 28 non-culprit segments imaged with NIRS-IVUS in the present analysis, only 1 (3.6%) had a maxLCBI4mm >400.
The novel observation in the present study is that NIRS imaging permitted identification of a large LCP underlying sudden cardiac arrest in vivo. These in vivo observations are in striking accord with prior autopsy observations implicating ruptured LCP in the pathogenesis of sudden cardiac death.