title: The decrease of plaque volume during percutaneous coronary intervention has a negative impact on coronary flow in acute myocardial infarction: a major role of percutaneous coronary intervention-induced embolization.
abstract: OBJECTIVE
  The aim of this study was to evaluate how decreased plaque volume during percutaneous coronary intervention (PCI) affects coronary flow in patients with acute myocardial infarction (AMI).
  
  
  BACKGROUND
  Coronary flow after reperfusion therapy is a major determinant of clinical outcomes in patients with AMI. However, little is still known about the changes in coronary flow that appear after PCI in response to the decreased plaque during the procedure.
  
  
  METHODS
  The study group comprised 60 patients with AMI who underwent pre- and post-PCI intravascular ultrasound (IVUS). Qualitative and quantitative analyses were performed on all IVUS procedures. External elastic membrane volume (EEMV), lumen volume (LV), and plaque volume (PV) were measured every 1.0 mm to include the lesion and reference segments 3.0 mm proximal and distal to the lesion. The difference between pre- and post-PCI PV was defined as the index of the decrease in plaque volume (DeltaPV). The corrected TIMI frame count (CTFC) was used to evaluate coronary flow after PCI.
  
  
  RESULTS
  Plaque volume was decreased at post-PCI IVUS in all 60 patients. Inadequate reflow (CTFC >40) was observed in 13 patients (21.7%). The decrease in PV was significantly larger in patients with inadequate reflow than in those with reflow (49.4 +/- 18.9 vs. 31.7 +/- 15.5 mm(3), p = 0.0010). Also, DeltaPV was significantly correlated with CTFC after PCI (r = 0.415, p = 0.0012).
  
  
  CONCLUSIONS
  The decrease in PV during PCI has a negative impact on coronary flow after PCI in patients with AMI. Embolization induced by PCI may occur in all patients with AMI.
authors.affiliation: Tsukazaki Memorial Hospital, Himeji, Japan. sato@tsukazaki.or.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sato
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Iida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.forename: Hidemasa
authors.initials: H
authors.lastname: Tanaka
authors.forename: Shinichi
authors.initials: S
authors.lastname: Shimodouzono
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
authors.forename: Takahiko
authors.initials: T
authors.lastname: Kawarabayashi
authors.forename: Junichi
authors.initials: J
authors.lastname: Yoshikawa
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D004617:Embolism / Q000209:etiology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D018084:Ultrasonography, Interventional