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Given that lipidic materials triggers the formation of calcification, lipidic materials could exist within calcified lesion, which may cause no-reflow phenomenon after PCI. The REASSURE-NIRS registry (NCT04864171) employed near-infrared spectroscopy and intravascular ultrasound imaging to evaluate maximum 4-mm lipid-core burden index (maxLCBI<jats:sub>4mm<\/jats:sub>) at target lesions containing small (maximum calcification arc\u2009&lt;\u2009180\u00b0: n\u2009=\u2009272) and large calcification (maximum calcification arc\u2009\u2265\u2009180\u00b0: n\u2009=\u2009189) in stable CAD patients. The associations of maxLCBI<jats:sub>4mm<\/jats:sub> with corrected TIMI frame count (CTFC) and no-reflow phenomenon after PCI were analyzed in patients with target lesions containing small and large calcification, respectively. No-reflow phenomenon occurred in 8.0% of study population. Receiver-operating characteristics curve analyses revealed that optimal cut-off values of maxLCBI<jats:sub>4mm<\/jats:sub> for predicting no-reflow phenomenon were 585 at small calcification (AUC\u2009=\u20090.72, p\u2009&lt;\u20090.001) and 679 at large calcification (AUC\u2009=\u20090.76, p\u2009=\u20090.001). Target lesions containing small calcification with maxLCBI<jats:sub>4mm<\/jats:sub>\u2009\u2265\u2009585 more likely exhibited a greater CTFC (p\u2009&lt;\u20090.001). In those with large calcification, 55.6% of them had maxLCBI<jats:sub>4mm<\/jats:sub>\u2009\u2265\u2009400 [vs. 56.2% (small calcification), p\u2009=\u20090.82]. Furthermore, a higher CTFC (p\u2009&lt;\u20090.001) was observed in association with maxLCBI<jats:sub>4mm<\/jats:sub>\u2009\u2265\u2009679 at large calcification. On multivariable analysis, maxLCBI<jats:sub>4mm<\/jats:sub> at large calcification still independently predicted no-reflow phenomenon (OR\u2009=\u20091.60, 95%CI\u2009=\u20091.32\u20131.94, p\u2009&lt;\u20090.001). MaxLCBI<jats:sub>4mm<\/jats:sub> at target lesions exhibiting large calcification elevated a risk of no-reflow phenomenon after PCI. Calcified plaque containing lipidic materials is not necessarily stable lesion, but could be active and high-risk one causing no-reflow phenomenon.<\/jats:p>","DOI":"10.1007\/s10554-023-02905-y","type":"journal-article","created":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T15:03:08Z","timestamp":1687964588000},"page":"1927-1941","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Calcified plaque harboring lipidic materials associates with no-reflow phenomenon after PCI in stable CAD"],"prefix":"10.1007","volume":"39","author":[{"given":"Hayato","family":"Hosoda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Kataoka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Nicholls","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishi","family":"Puri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kota","family":"Murai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Kitahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Mitsui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Sugane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichiro","family":"Sawada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takamasa","family":"Iwai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Matama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Honda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensuke","family":"Takagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Fujino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuichi","family":"Yoneda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumiyuki","family":"Otsuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itaru","family":"Takamisawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensaku","family":"Nishihira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhide","family":"Asaumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuya","family":"Kawai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teruo","family":"Noguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,28]]},"reference":[{"key":"2905_CR1","doi-asserted-by":"publisher","first-page":"2148","DOI":"10.1161\/01.CIR.0000015697.59592.07","volume":"105","author":"A Tanaka","year":"2002","unstructured":"Tanaka A, Kawarabayashi T, Nishibori Y, Sano T, Nishida Y, Fukuda D et al (2002) No-reflow phenomenon and lesion morphology in patients with acute myocardial infarction. 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Other authors have nothing to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Yu Kataoka has received research support from Nipro and Abbott, and and honoraria from Nipro, Abbott, Kowa, Amgen, Sanofi, Astellas, Takeda and Daiichi-Sankyo. Other authors have nothing to disclose.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the institutional review board of the National Cerebral and Cardiovascular Center (M30-084-4), the Miyazaki Medical Association Hospital (2020-43) and Sakakibara Heart Institute. Written informed consent was not obtained in each subject due to the observational analysis of hospitalized patients.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}