Acute myocardial infarction: clinical characteristics and plaque morphology between expansive remodeling and constrictive remodeling by intravascular ultrasound.
BACKGROUND
According to recent intravascular ultrasound (IVUS) studies, expansive remodeling (ER) at the culprit lesion has been observed in almost 50% of patients with acute coronary syndrome and constrictive remodeling (CR) in 30%. The purpose of this study is to investigate the difference between ER and CR at the culprit lesion in patients with acute myocardial infarction (AMI).


RESULTS
Preinterventional IVUS images of 73 patients with AMI were identified. The remodeling index (RI) was defined as the ratio of the external elastic membrane (EEM) areas at the culprit lesion to the EEM areas at the proximal reference site. Expansive remodeling was defined as an RI > 1.05; CR, as an RI < 0.95. In patients with AMI, 40 patients (55%) showed ER on IVUS, whereas CR was observed in 18 patients (25%). Patients with ER were significantly older than those with CR (P < .005). The frequency of the presence of calcifications was higher in patients with ER than in those with CR (P < .0005). In patients with AMI with ER, soft plaque with small calcium was the most frequent (58%). Multivariate analysis revealed that age and the presence of calcifications remained as independent predictors of ER.


CONCLUSIONS
These findings suggest that ER relates to old age and calcification, and CR may contribute to early plaque progression than ER in patients with AMI.
Hasegawa
Takao
T
Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Ehara
Shoichi
S
Kobayashi
Yoshiki
Y
Kataoka
Toru
T
Yamashita
Hajime
H
Nishioka
Hiroki
H
Asawa
Koichiro
K
Yamagishi
Hiroyuki
H
Yoshiyama
Minoru
M
Takeuchi
Kazuhide
K
Yoshikawa
Junichi
J
Ueda
Makiko
M
D000367:Age Factors; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D012044:Regression Analysis; D018709:Statistics, Nonparametric