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Impact of plaque components on no-reflow phenomenon after stent deployment in patients with acute coronary syndrome: a virtual histology-intravascular ultrasound analysis.
- Source :
-
European heart journal [Eur Heart J] 2011 Aug; Vol. 32 (16), pp. 2059-66. Date of Electronic Publication: 2009 Feb 19. - Publication Year :
- 2011
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Abstract
- 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.<br />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).<br />Conclusion: In ACS patients, post-stenting no-reflow is associated with plaque components defined by VH-IVUS analysis with larger NC and more TCFAs.
- Subjects :
- Acute Coronary Syndrome diagnostic imaging
Acute Coronary Syndrome pathology
Aged
Female
Humans
Male
Middle Aged
No-Reflow Phenomenon diagnostic imaging
No-Reflow Phenomenon pathology
Plaque, Atherosclerotic diagnostic imaging
Plaque, Atherosclerotic pathology
Predictive Value of Tests
Retrospective Studies
Ultrasonography, Interventional
Acute Coronary Syndrome surgery
No-Reflow Phenomenon etiology
Plaque, Atherosclerotic complications
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1522-9645
- Volume :
- 32
- Issue :
- 16
- Database :
- MEDLINE
- Journal :
- European heart journal
- Publication Type :
- Academic Journal
- Accession number :
- 19228713
- Full Text :
- https://doi.org/10.1093/eurheartj/ehp034