Document Detail


Impact of attenuated plaque as detected by intravascular ultrasound on the occurrence of microvascular obstruction after percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.
MedLine Citation:
PMID:  23871509     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of the study was to investigate whether intravascular ultrasound (IVUS) can predict microvascular obstruction (MVO) as detected by magnetic resonance imaging (MRI) after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
BACKGROUND: MVO occurs in a sizable proportion of patients with acute myocardial infarction despite successful PCI and results in poor clinical outcomes.
METHODS: We assessed infarct-related lesions in 68 patients with STEMI by using IVUS before primary PCI. All patients were examined by MRI 1 week after primary PCI.
RESULTS: MRI-derived MVO was seen in 23 patients (34%). In the IVUS assessment, the frequency of plaque rupture, echolucent plaque, calcification and positive remodeling, and quantitative geometric data were not different between the MVO group and the no-MVO group. Although the frequency of plaque with ultrasound attenuation was similar between the 2 groups (87% vs. 89%, p = 0.999), the maximum attenuation angle (280° [range: 215° to 360°] vs. 150° [range: 95° to 300°], p = 0.008) and attenuation length (11.3 mm [range: 7.2 to 17.8 mm] vs. 6.8 mm [range: 3.0 to 10.4 mm], p = 0.009) were significantly greater in the MVO group than the no-MVO group. Multivariable logistic regression analysis showed that attenuated plaque with a maximum attenuation angle of >180° and attenuation length of >5 mm was an independent predictor of MVO (odds ratio: 6.07, 95% confidence interval: 1.89 to 19.53, p = 0.002).
CONCLUSIONS: Attenuated plaque with maximum attenuation angle of >180° and attenuation length of >5 mm was associated with the occurrence of MVO after primary PCI. IVUS might to be a useful tool for risk stratification in STEMI patients undergoing primary PCI.
Authors:
Yasutsugu Shiono; Takashi Kubo; Atsushi Tanaka; Takashi Tanimoto; Shingo Ota; Yasushi Ino; Hiroshi Aoki; Yuichi Ozaki; Makoto Orii; Kunihiro Shimamura; Kohei Ishibashi; Takashi Yamano; Tomoyuki Yamaguchi; Kumiko Hirata; Toshio Imanishi; Takashi Akasaka
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2013-07-17
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  6     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-08-23     Completed Date:  2014-03-24     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:  847-53     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Chi-Square Distribution
Coronary Angiography
Coronary Artery Disease / complications,  physiopathology,  therapy*,  ultrasonography
Coronary Circulation*
Coronary Occlusion / etiology*,  physiopathology,  ultrasonography
Coronary Vessels / physiopathology,  ultrasonography*
Female
Humans
Logistic Models
Magnetic Resonance Imaging
Male
Microcirculation*
Middle Aged
Multivariate Analysis
Myocardial Infarction / etiology,  physiopathology,  therapy*,  ultrasonography
Odds Ratio
Percutaneous Coronary Intervention / adverse effects*
Plaque, Atherosclerotic*
Predictive Value of Tests
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Ultrasonography, Interventional*

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


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