Document Detail


Impact of ultrasound attenuation and plaque rupture as detected by intravascular ultrasound on the incidence of no-reflow phenomenon after percutaneous coronary intervention in ST-segment elevation myocardial infarction.
MedLine Citation:
PMID:  20488411     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of this study was to assess whether ultrasound attenuation and plaque rupture as detected by intravascular ultrasound (IVUS) are associated with the incidence of no-reflow phenomenon after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
BACKGROUND: No-reflow phenomenon is associated with worse long-term outcomes after STEMI. Therefore, reliable and feasible intravascular imaging techniques are needed to identify patient subgroups that would be at high risk for no-reflow phenomenon.
METHODS: One hundred seventy consecutive patients with STEMI who underwent PCI within 12 h after symptom onset were enrolled. The IVUS interrogation was performed before PCI.
RESULTS: No-reflow phenomenon occurred in 30 patients (18%), who had a higher incidence of no ST-segment resolution (50% vs. 9%; p < 0.001), a higher peak creatine kinase level (4,090 IU/l vs. 2,823 IU/l; p < 0.001), and a lower left ventricular ejection fraction in the chronic phase (51% vs. 59%; p < 0.01). Multivariate logistic regression analysis revealed that ultrasound attenuation with a longitudinal length of > or =5 mm, plaque rupture, and reperfusion time correlated with no-reflow phenomenon (all p < 0.05). In patients with both ultrasound attenuation > or =5 mm and plaque rupture, the incidence of no-reflow phenomenon was 88%, and the risk of decreased coronary reflow was higher than that predicted by either factor alone (p = 0.004 for interaction).
CONCLUSIONS: In patients with STEMI, a longer ultrasound attenuation and plaque rupture on IVUS are associated with an increased incidence of no-reflow phenomenon, suggesting that this subset of patients might be at high risk for distal embolism.
Authors:
Mitsuaki Endo; Kiyoshi Hibi; Tomoaki Shimizu; Naohiro Komura; Ikuyoshi Kusama; Fumiyuki Otsuka; Takayuki Mitsuhashi; Noriaki Iwahashi; Jun Okuda; Kengo Tsukahara; Masami Kosuge; Toshiaki Ebina; Satoshi Umemura; Kazuo Kimura
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  3     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-21     Completed Date:  2010-08-30     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:  540-9     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary / adverse effects*
Chi-Square Distribution
Coronary Angiography
Coronary Artery Disease / complications,  physiopathology,  therapy*,  ultrasonography*
Coronary Circulation*
Female
Humans
Incidence
Logistic Models
Male
Middle Aged
Myocardial Infarction / etiology,  physiopathology,  therapy*,  ultrasonography*
No-Reflow Phenomenon / etiology*,  ultrasonography
Odds Ratio
Predictive Value of Tests
Reproducibility of Results
Retrospective Studies
Risk Assessment
Risk Factors
Rupture
Treatment Outcome
Ultrasonography, Interventional*
Ventricular Function, Left

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