Impact of plaque components on no-reflow phenomenon after stent deployment in patients with acute coronary syndrome: a virtual histology-intravascular ultrasound analysis
| Autor: | Youngkeun Ahn, Won Yu Kang, Hyung Wook Park, Ju Han Kim, Soo Hyun Kim, Jeong Gwan Cho, Young Joon Hong, Nam Sik Yoon, Jong Chun Park, Doo Sun Sim, Jung Chaee Kang, Shin Eun Lee, Min Goo Lee, Kye Hun Kim, Jum Suk Ko, Hyun Ju Youn, Keun Ho Park, Yun Ha Choi, Myung Ho Jeong |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Acute coronary syndrome medicine.medical_treatment Lumen (anatomy) Culprit Clinical Research Predictive Value of Tests Humans Medicine Ultrasonics cardiovascular diseases Acute Coronary Syndrome Ultrasonography Interventional Plaque Aged Retrospective Studies Coronary disease business.industry Ultrasound Stent Middle Aged medicine.disease Interventional Cardiology Plaque Atherosclerotic Predictive value of tests No reflow phenomenon No-Reflow Phenomenon Stents Female Radiology Cardiology and Cardiovascular Medicine business Nuclear medicine TIMI |
| Zdroj: | European Heart Journal |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehp034 |
| Popis: | Aims We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relation between coronary plaque characteristics and no-reflow in acute coronary syndrome (ACS) patients. Methods and results A total of 190 consecutive ACS patients were imaged using VH-IVUS and analysed retrospectively. Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2 after stenting. Virtual histology-intravascular ultrasound classified the colour-coded tissue into four major components: fibrotic, fibro-fatty, dense calcium, and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (≥10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden ≥40%. Of the 190 patients studied at pre-stenting, no-reflow was observed in 24 patients (12.6%) at post-stenting. The absolute and %NC areas at the minimum lumen sites (1.6 ± 1.2 vs. 0.9 ± 0.8 mm2, P < 0.001, and 24.5 ± 14.3 vs. 16.1 ± 10.6%, P = 0.001, respectively) and the absolute and %NC volumes (30 ± 24 vs. 16 ± 17 mm3, P = 0.001, and 22 ± 11 vs. 14 ± 8%, P < 0.001, respectively) were significantly greater, and the presence of at least one TCFA and multiple TCFAs within culprit lesions (71 vs. 36%, P = 0.001, and 38 vs. 15%, P = 0.005, respectively) was significantly more common in the no-reflow group compared with the normal-reflow group. In the multivariable analysis, %NC volume was the only independent predictor of no-reflow (odds ratio = 1.126; 95% CI 1.045–1.214, P = 0.002). Conclusion In ACS patients, post-stenting no-reflow is associated with plaque components defined by VH-IVUS analysis with larger NC and more TCFAs. |
| Databáze: | OpenAIRE |
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