• Ryan D Madder, Rishi Puri, James E Muller, Jan Harnek, Matthias Götberg, Stacie VanOosterhout, Margaret Chi, David Wohns, Richard McNamara, Kathy Wolski, Sean Madden, Samuel Sidharta, Jordan Andrews, Stephen J Nicholls, and David Erlinge.
• From the Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (R.D.M., S.V.O., M.C., D.W., R.M.N.); Cleveland Clinic Coordinating Center for Clinical Research (C5Research), OH (R.P., K.W.); Infraredx, Inc, Burlington, MA (J.E.M., S.M.); Department of Cardiology, Lund University, Lund, Sweden (J.H., M.G., D.E.); and Department of Medicine (S.S.) and South Australian Health and Medical Research Institute (J.A., S.J.N.), Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia. ryan.madder@spectrumhealth.org.
• Arterioscler. Thromb. Vasc. Biol. 2016 May 1; 36 (5): 1010-5.

ObjectiveIn a previous exploratory analysis, intracoronary near-infrared spectroscopy (NIRS) found the majority of culprit lesions in ST-segment-elevation myocardial infarction (STEMI) to contain a maximum lipid core burden index in 4 mm (maxLCBI4mm) of >400. This initial study was limited by a small sample size, enrollment at a single center, and post hoc selection of the maxLCBI4mm ≥400 threshold. This study was designed a priori to substantiate the ability of NIRS to discriminate STEMI culprit from nonculprit segments and to confirm the performance of the maxLCBI4mm ≥400 threshold.Approach And ResultsAt 2 centers in the United States and Sweden, 75 STEMI patients underwent intracoronary NIRS imaging after establishing thrombolysis in myocardial infarction 3 flow, but before stenting. Blinded core laboratory analysis defined the culprit segment as the 10-mm segment distal to the proximal angiographic culprit margin. The remaining vessel was divided into contiguous 10-mm nonculprit segments. The maxLCBI4mm of culprit segments (median [interquartile range]: 543 [273-756]) was 4.4-fold greater than nonculprit segments (median [interquartile range]: 123 [0-307]; P<0.001). Receiver-operating characteristic analysis demonstrated that maxLCBI4mm differentiated culprit from nonculprit segments with high accuracy (c-statistic=0.83; P<0.001). A threshold maxLCBI4mm ≥400 identified STEMI culprit segments with a sensitivity of 64% and specificity of 85%.ConclusionsThis study substantiates the ability of NIRS to accurately differentiate STEMI culprit from nonculprit segments and confirms that a threshold maxLCBI4mm ≥400 is detected by NIRS in the majority of STEMI culprits.© 2016 American Heart Association, Inc.

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