Calcified atheroma has been viewed conventionally as stable lesion which less likely increases no-reflow phenomenon. 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_4mm) at target lesions containing small (maximum calcification arc < 180°: n = 272) and large calcification (maximum calcification arc ≥ 180°: n = 189) in stable CAD patients. The associations of maxLCBI_4mm 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_4mm for predicting no-reflow phenomenon were 585 at small calcification (AUC = 0.72, p < 0.001) and 679 at large calcification (AUC = 0.76, p = 0.001). Target lesions containing small calcification with maxLCBI_4mm ≥ 585 more likely exhibited a greater CTFC (p < 0.001). In those with large calcification, 55.6% of them had maxLCBI_4mm ≥ 400 [vs. 56.2% (small calcification), p = 0.82]. Furthermore, a higher CTFC (p < 0.001) was observed in association with maxLCBI_4mm ≥ 679 at large calcification. On multivariable analysis, maxLCBI_4mm at large calcification still independently predicted no-reflow phenomenon (OR = 1.60, 95%CI = 1.32–1.94, p < 0.001). MaxLCBI_4mm 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.

钙化粥样斑块传统上被视为稳定的病变，不太可能增加无复流现象。由于脂质物质会引发钙化的形成，钙化病灶内存在脂质物质，可能会导致PCI术后无复流现象。REASSURE-NIRS 注册 (NCT04864171) 采用近红外光谱和血管内超声成像来评估包含小（最大钙化弧 < 180°：n = 272）_和稳定 CAD 患者出现大面积钙化（最大钙化弧≥ 180°：n = 189）。在靶病灶含有小钙化和大钙化的患者中，分别分析maxLCBI _4mm与校正 TIMI 帧计数 (CTFC) 和 PCI 后无复流现象的关系。8.0%的研究人群出现无复流现象。接受者操作特征曲线分析显示，预测无复流现象的maxLCBI _4mm的最佳截止值在小钙化处为 585（AUC = 0.72，p < 0.001），在大钙化处为 679（AUC = 0.76，p = 0.001） 。含有小钙化且 maxLCBI _4mm  ≥ 585 的目标病灶更有可能表现出更大的 CTFC (p < 0.001)。在钙化较大的患者中，55.6% 的 maxLCBI _4mm  ≥ 400 [vs. 56.2%（小钙化），p = 0.82]。 此外，在大钙化处观察到较高的 CTFC (p < 0.001) 与 maxLCBI _4mm ≥ 679相关。在多变量分析中，大钙化处的 maxLCBI _4mm仍然独立预测无复流现象（OR = 1.60，95%CI = 1.32–1.94，p < 0.001）。目标病灶处的MaxLCBI _4mm出现大面积钙化会增加 PCI 后出现无复流现象的风险。含有脂质物质的钙化斑块不一定是稳定的病变，但可能是活跃的且高风险的病变，导致无复流现象。