Document Detail


Effect of renal function on ultrasonic coronary plaque characteristics in patients with acute myocardial infarction.
MedLine Citation:
PMID:  20346309     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We used intravascular ultrasonography to assess plaque morphology and morphometry in 310 patients with acute myocardial infarction (125 with ST-segment elevation and 185 with non-ST-segment elevation myocardial infarction) with varying degrees of renal dysfunction according to the creatinine clearance (CrCl): CrCl >70 ml/min in 153, CrCl of 30 to 69 ml/min in 103, and CrCl of <30 ml/min in 54 patients, including 20 patients requiring dialysis). The lesion site plaque burden was greatest (77.4 +/- 11.0% vs 79.8 +/- 12.5% vs 82.0 +/- 10.3%, p = 0.031) and the lesion was longest (20.9 +/- 9.1 vs 23.1 +/- 9.5 vs 26.3 +/- 9.6 mm, p = 0.038) in the lowest CrCl group. Infarct-related artery plaque rupture (31.4% vs 34.0% vs 53.7%, p = 0.011) and multiple plaque ruptures (11.1% vs 12.6% vs 33.3%, p <0.001) were the most common, the ruptured plaque cavities were the largest (1.98 +/- 0.89 vs 2.20 +/- 1.45 vs 3.06 +/- 1.70 mm(2), p = 0.002), and the ruptured plaque was longest (2.33 +/- 0.93 vs 2.59 +/- 1.50 vs 3.33 +/- 1.76 mm, p = 0.008) in the lowest CrCl group (<30 ml/min). Intravascular ultrasound-detected thrombus was observed most frequently in the lowest CrCl group (22.9% vs 23.3% vs 40.7%, p = 0.027). CrCl was the one of the independent predictors of culprit lesion plaque rupture (odds ratio 0.979, 95% confidence interval 0.963 to 0.994, p = 0.008). During 1 year of follow-up, the incidence of nonfatal myocardial infarction (2.6% vs 4.9% vs 11.1%, p = 0.044) and cardiac death (3.9% vs 6.8% vs 14.8%, p = 0.024) was greatest in the lowest CrCl group. Also, a strong trend was found toward the greatest incidence of stent thrombosis (2.0% vs 3.9% vs 9.3%, p = 0.057) in the lowest CrCl group. In conclusion, patients with acute myocardial infarction and significant renal dysfunction had more plaque vulnerability compared to those with normal renal function. This might be associated with poor clinical outcomes in patients with acute myocardial infarction and renal dysfunction.
Authors:
Young Joon Hong; Myung Ho Jeong; Yun Ha Choi; Eun Hye Ma; Jum Suk Ko; Min Goo Lee; Keun Ho Park; Doo Sun Sim; Nam Sik Yoon; Hyun Ju Youn; Kye Hun Kim; Hyung Wook Park; Ju Han Kim; Youngkeun Ahn; Jeong Gwan Cho; Jong Chun Park; Gary S Mintz; Neil J Weissman; Jung Chaee Kang
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  105     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-29     Completed Date:  2010-04-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  936-42     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Heart Research Center, Chonnam National University Hospital, Gwangju, Korea.
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MeSH Terms
Descriptor/Qualifier:
Aged
Arteries / ultrasonography
Coronary Angiography
Coronary Thrombosis / ultrasonography
Coronary Vessels / ultrasonography*
Death, Sudden, Cardiac
Female
Follow-Up Studies
Humans
Kidney / physiology*
Kidney Diseases / complications
Male
Middle Aged
Myocardial Infarction / complications,  radiography,  ultrasonography*
Retrospective Studies
Rupture, Spontaneous
Ultrasonography, Interventional*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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