Document Detail


Assessment of echo-attenuated plaque by optical coherence tomography and its impact on post-procedural creatine kinase-myocardial band elevation in elective stent implantation.
MedLine Citation:
PMID:  21596319     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study examined morphological characteristics of echo-attenuated plaques by optical coherence tomography (OCT) and evaluated their influence on creatine kinase-myocardial band (CK-MB) elevation after percutaneous coronary intervention (PCI) in patients with elective stent implantation.
BACKGROUND: Recent intravascular ultrasound studies have described atherosclerotic plaques with echo attenuation (EA) without associated bright echoes that are correlated with no-reflow phenomenon after PCI.
METHODS: We studied 135 native de novo culprit coronary lesions in 135 patients with normal pre-PCI CK-MB levels (28 with unstable angina; 107 with stable angina) who underwent intravascular ultrasound and OCT examinations before elective stent implantation. The lesions were divided into 2 groups based on the presence or absence of EA, and OCT findings were compared. We then determined predictors of post-PCI CK-MB elevation.
RESULTS: EA was found in 47 (34.8%) lesions and was associated with the presence of OCT-derived thin-capped fibroatheroma, ruptured plaques, greater lipid content, intravascular ultrasound-derived large reference and plaque area, lesion eccentricity, and microcalcification. Elevated CK-MB levels were observed in 36 (26.7%) lesions, and significantly more frequently in lesions with EA than without. In multivariable analysis, EA (odds ratio [OR]: 3.49; 95% confidence interval [CI]: 1.53 to 7.93; p = 0.003) and OCT-derived ruptured plaque (OR: 2.92; 95% CI: 1.21 to 7.06; p = 0.017) were independent predictors of post-PCI CK-MB elevation.
CONCLUSIONS: Atherosclerotic plaques with EA were associated with characteristics considered to be high risk or unstable. OCT examination showed an additive predictive value to the presence of EA for post-PCI CK-MB elevation.
Authors:
Tetsumin Lee; Tsunekazu Kakuta; Taishi Yonetsu; Kentaro Takahashi; Ginga Yamamoto; Yoshito Iesaka; Hideomi Fujiwara; Mitsuaki Isobe
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  4     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-20     Completed Date:  2011-09-09     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  483-91     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina Pectoris / etiology,  therapy
Angina, Unstable / etiology,  therapy
Angioplasty, Balloon, Coronary / adverse effects,  instrumentation*
Biological Markers / blood
Chi-Square Distribution
Coronary Angiography
Coronary Artery Disease / complications,  diagnosis,  therapy*
Creatine Kinase, MB Form / blood*
Female
Heart Diseases / enzymology,  etiology*
Humans
Japan
Male
Middle Aged
Odds Ratio
Plaque, Atherosclerotic / complications,  diagnosis,  therapy*
Predictive Value of Tests
Prospective Studies
Risk Assessment
Risk Factors
Rupture, Spontaneous
Stents*
Time Factors
Tomography, Optical Coherence*
Treatment Outcome
Ultrasonography, Interventional*
Up-Regulation
Chemical
Reg. No./Substance:
0/Biological Markers; EC 2.7.3.2/Creatine Kinase, MB Form
Comments/Corrections
Comment In:
JACC Cardiovasc Interv. 2011 May;4(5):492-4   [PMID:  21596320 ]

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