Document Detail

Ruptured plaque is associated with larger infarct size following successful percutaneous coronary intervention in ST segment elevation acute myocardial infarction.
MedLine Citation:
PMID:  19424058     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pathological studies report that acute ST segment elevation myocardial infarction (STEMI) is caused not only by plaque rupture but also by other causes, such as erosion. To test our hypothesis that different lesion morphologies result in different clinical outcomes, we used intravascular ultrasound (IVUS) to investigate the relationship between lesion morphology and infarct size after successful primary angioplasty. METHODS: Our 72 consecutive first anterior STEMI patients underwent preintervention IVUS and were successfully recanalized with primary angioplasty. Using echocardiography, we analyzed left-ventricular wall motion to obtain a Wall Motion Score Index (WMSI) before angioplasty and 1 month after the onset, and used thallium myocardial scintigraphy 1 month after the onset to obtain computer-generated severity scores. Patients were divided into a rupture group (n = 30) and a nonrupture group (n = 42) on the basis of preintervention IVUS findings. RESULTS: Peak creatine kinase levels (3150+/-357 vs. 2256+/-238 IU/l, P = 0.03) and severity score (758+/-114 vs. 474+/-75, P = 0.03) in the rupture group were significantly higher. Despite there being no difference in baseline WMSI (1.55+/-0.04 vs. 1.58+/-0.03, P = 0.45), improvement in WMSI in the rupture group was significantly less pronounced (0.08+/-0.02 vs. 0.18+/-0.03, P = 0.01). CONCLUSION: STEMI caused by plaque rupture is associated with a large degree of myocardial damage and poor functional recovery as compared with STEMI of different etiologies, even after successful primary angioplasty. Our results suggest that lesion morphology may affect clinical outcomes.
Atsushi Tanaka; Kenei Shimada; Masashi Namba; Toshihiko Sano; Tsunemori Sakamoto; Takashi Akasaka; Junichi Yoshikawa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Coronary artery disease     Volume:  20     ISSN:  1473-5830     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-14     Completed Date:  2009-07-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  260-6     Citation Subset:  IM    
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary*
Biological Markers / blood
Coronary Angiography
Coronary Artery Disease / complications*,  diagnosis,  physiopathology,  therapy
Creatine Kinase / blood
Image Interpretation, Computer-Assisted
Middle Aged
Myocardial Contraction
Myocardial Infarction / etiology,  pathology,  physiopathology,  therapy*
Myocardial Perfusion Imaging
Myocardium / enzymology,  pathology*
Prospective Studies
Recovery of Function
Severity of Illness Index
Thallium Radioisotopes / diagnostic use
Tomography, Emission-Computed, Single-Photon
Treatment Outcome
Ultrasonography, Interventional
Ventricular Function, Left
Reg. No./Substance:
0/Biological Markers; 0/Thallium Radioisotopes; EC Kinase

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