Document Detail

Computed tomographic angiography-verified plaque characteristics and slow-flow phenomenon during percutaneous coronary intervention.
MedLine Citation:
PMID:  22721658     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study sought to identify whether computed tomographic angiographic (CTA) plaque characteristics are associated with slow-flow phenomenon (SF) during percutaneous coronary intervention (PCI).
BACKGROUND: SF during PCI is associated with myocardial damage and prolonged hospitalization. Intracoronary ultrasound-verified large echolucent lesions have been reported to predict SF.
METHODS: The authors evaluated pre-PCI CTA plaque characteristics in 40 consecutive patients (male/female, 31/9; age, 69 ± 10 years) with stable angina pectoris who developed SF during PCI; patients with ≥ 600 Agatston coronary artery calcium score were not included. They were compared with 40 age-, sex-, and culprit coronary artery-matched patients (male/female, 31/9; age, 69 ± 9 years) who underwent PCI during the same period and did not develop SF. Plaque characteristics, including vascular remodeling, plaque consistency, including low-attenuation plaques representing lipid-rich lesions and high-attenuation plaque patterns of calcium deposition, were analyzed.
RESULTS: Calcium deposition in the perimeter of a plaque, or circumferential plaque calcification (CPC), was significantly more frequent in the SF group (25 of 40, 63%) than the no-SF group (2 of 40, 5.0%) (p < 0.001). Presence of CPC on CTA was confirmed at the same location in the nonenhanced CT during Agatston coronary artery calcium score calculation. The positive remodeling index was significantly higher (1.5 [1.3 to 1.8] vs. 1.2 [1.0 to 1.5]; p < 0.001) and plaque density significantly lower (23.5 [9.5 to 40] HU vs. 45 [29 to 86] HU; p = 0.001) in the SF group. The conditional logistic regression analysis revealed that CPC, plaque density, and dyslipidemia were the predictors of SF, with CPC being the strongest (odds ratio: 79; 95% confidence interval: 8 to 783, p < 0.0001).
CONCLUSIONS: CTA-verified CPC with low-attenuation plaque and positive remodeling were determinants of SF during PCI. If CTA findings are available in patients undergoing PCI, the interventionists should be aware of the likelihood of SF.
Takahide Kodama; Takeshi Kondo; Akitsugu Oida; Shinichiro Fujimoto; Jagat Narula
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  5     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-06-22     Completed Date:  2012-10-29     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:  636-43     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Angina, Stable / radiography,  therapy
Angioplasty, Balloon, Coronary / adverse effects*
Chi-Square Distribution
Coronary Angiography / methods*
Coronary Artery Disease / physiopathology,  radiography*,  therapy*
Coronary Circulation
Coronary Vessels / pathology*,  physiopathology
Logistic Models
Middle Aged
No-Reflow Phenomenon / etiology,  physiopathology,  radiography*
Odds Ratio
Plaque, Atherosclerotic
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Risk Factors
Tomography, X-Ray Computed*
Treatment Outcome
Vascular Calcification / radiography,  therapy
Comment In:
JACC Cardiovasc Interv. 2012 Jun;5(6):644-5   [PMID:  22721659 ]

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