Impact of Plaque Components on No-reflow Phenomenon After Stent Deployment in Patients with Acute Coronary Syndrome: a Virtual Histology-intravascular Ultrasound Analysis

Overview

Journal Eur Heart J

Publisher Oxford University Press

Specialty Cardiology & Vascular Diseases

Date 2009 Feb 21

PMID 19228713

Citations 35

Authors

Young Joon Hong

Myung Ho Jeong

Yun Ha Choi

Jum Suk Ko

Min Goo Lee

Won Yu Kang

Shin Eun Lee

Soo Hyun Kim

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

Jung Chaee Kang

Affiliations

Soon will be listed here.

Abstract

Aims: We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relation between coronary plaque characteristics and no-reflow in acute coronary syndrome (ACS) patients.

Methods And Results: A total of 190 consecutive ACS patients were imaged using VH-IVUS and analysed retrospectively. Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2 after stenting. Virtual histology-intravascular ultrasound classified the colour-coded tissue into four major components: fibrotic, fibro-fatty, dense calcium, and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (≥10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden≥40%. Of the 190 patients studied at pre-stenting, no-reflow was observed in 24 patients (12.6%) at post-stenting. The absolute and %NC areas at the minimum lumen sites (1.6±1.2 vs. 0.9±0.8 mm2, P<0.001, and 24.5±14.3 vs. 16.1±10.6%, P=0.001, respectively) and the absolute and %NC volumes (30±24 vs. 16±17 mm3, P=0.001, and 22±11 vs. 14±8%, P<0.001, respectively) were significantly greater, and the presence of at least one TCFA and multiple TCFAs within culprit lesions (71 vs. 36%, P=0.001, and 38 vs. 15%, P=0.005, respectively) was significantly more common in the no-reflow group compared with the normal-reflow group. In the multivariable analysis, %NC volume was the only independent predictor of no-reflow (odds ratio=1.126; 95% CI 1.045-1.214, P=0.002).

Conclusion: In ACS patients, post-stenting no-reflow is associated with plaque components defined by VH-IVUS analysis with larger NC and more TCFAs.

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