Saphenous vein graft near‐infrared spectroscopy imaging insights from the lipid core plaque association with clinical events near‐infrared spectroscopy (ORACLE‐NIRS) registry

Abstract

Objectives We sought to examine near-infrared spectroscopy (NIRS) imaging findings of aortocoronary saphenous vein grafts (SVGs). Background SVGs are prone to develop atherosclerosis similar to native coronary arteries. They have received little study using NIRS. Methods We examined the clinical characteristics and imaging findings from 43 patients who underwent NIRS imaging of 45 SVGs at our institution between 2009 and 2016. Results The mean patient age was 67 ± 7 years and 98% were men, with high prevalence of diabetes mellitus (56%), hypertension (95%), and dyslipidemia (95%). Mean SVG age was 7 ± 7 years, mean SVG lipid core burden index (LCBI) was 53 ± 60 and mean maxLCBI4mm was 194 ± 234. Twelve SVGs (27%) had lipid core plaques (2 yellow blocks on the block chemogram), with a higher prevalence in SVGs older than 5 years (46% vs. 5%, p=0.002). Older SVG age was associated with higher LCBI (r=0.480, p<0.001) and higher maxLCBI4mm (r=0.567, p<0.001). On univariate analysis, greater annual total cholesterol exposure was associated with higher SVG LCBI (r=0.30, p=0.042) and annual LDL-cholesterol and triglyceride exposure were associated with higher SVG maxLCBI4mm (LDL-C: r=0.41, p=0.020; triglycerides: r=0.36, p=0.043). On multivariate analysis, the only independent predictor of SVG LCBI and maxLCBI4mm was SVG age. SVG percutaneous coronary intervention was performed in 63% of the patients. An embolic protection device was used in 96% of SVG PCIs. Periprocedural myocardial infarction occurred in one patient. Conclusions Older SVG age and greater lipid exposure are associated with higher SVG lipid burden.

Inflammation in Vein Graft Disease

“…Comparable to native atherosclerosis, hypercholesterolemia, an import driver of VGD and lipid burden, is clearly associated with vein graft age ( 159 ). Analysis of human vein grafts obtained at autopsy has shown that coronary vein grafts undergo rapid atherosclerotic lesion development ( 24 ).…”

A five-parameter score for predicting saphenous vein graft degenerative and/or occlusive disease in recurring ischemic symptoms after one year post coronary artery bypass grafting

“…In a near-infrared spectroscopy imaging study, SVG age was associated with higher lipid core burden index, its only independent predictor, and angiographic stenosis was significantly greater among SVGs aged 5 years and older. 25 In several studies, SVG age was greater in SVGD group versus patent SVG group and was an independent predictor of SVGD 26,27 ; in one study it correlated negatively with stable angina and positively with MHR. 26…”

“…In a near-infrared spectroscopy imaging study, SVG age was associated with higher lipid core burden index, its only independent predictor, and angiographic stenosis was significantly greater among SVGs aged 5 years and older. 25 In several studies, SVG age was greater in SVGD group versus patent SVG group and was an independent predictor of SVGD 26,27 ; in one study it correlated negatively with stable angina and positively with MHR. 26 In the present primary cohort, patients with acute coronary syndrome after CABG had worse NYHA class and greater LVEDD than patients with stable angina pectoris (p = .005 and p = .0002, respectively), and acute coronary syndrome after CABG was an independent multivariate predictor of SVGD.…”

The influence of high-density lipoprotein cholesterol on maximal lipid core burden indexing thin cap fibrous atheroma lesions as assessed by near infrared spectroscopy

“…It needs to be highlighted that only periprocedural lipid plasma levels were measured with no insight into long-term analysis. Danek et al [ 40 ] studied the progression of atherosclerosis in saphenous vein grafts and revealed that in contrast to the LDL-C and TG measured annually, the periprocedural measurements showed no association with max LCBI 4mm . It was also found that annual measurements are more representative for the assessment of plaque morphology.…”