Impact of culprit plaque composition on the no-reflow phenomenon in patients with acute coronary syndrome: an intravascular ultrasound radiofrequency analysis.
BACKGROUND
The difference in the culprit plaque composition of acute coronary syndrome (ACS) patients with and without the no-reflow phenomenon has not been fully evaluated.


RESULTS
Intravascular ultrasound radiofrequency data of culprit plaques were obtained and analyzed in 49 ACS patients. The no-reflow phenomenon was defined as a decrease of at least 1 grade in 'Thrombolysis In Myocardial Infarction' flow immediately after mechanical dilatation compared with before mechanical dilatation, with no evidence of thrombus, spasm, or dissection. The no-reflow phenomenon was observed in 9 individuals. Culprit plaques with the no-reflow phenomenon contained a higher percentage of necrotic core component and a smaller percentage of fibrous component than plaques in the patients without the no-reflow phenomenon (necrotic core component, 22.1+/-9.3% vs 11.7+/-7.9%, p=0.0011; fibrous component, 59.6+/-11.2% vs 68.3+/-10.2%, p=0.027). Multivariate analysis identified the percentage of necrotic core component as an independent predictor of the no-reflow phenomenon after adjustment for plaque geometry and procedural factors (odds ratio, 1.7; 95% confidence interval, 1.1 to 2.5; p=0.015).


CONCLUSIONS
Culprit plaques of patients with the no-reflow phenomenon differ from those in patients without the no-reflow phenomenon.
Higashikuni
Yasutomi
Y
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Tanabe
Kengo
K
Tanimoto
Shuzou
S
Aoki
Jiro
J
Yamamoto
Hirosada
H
Nakazawa
Gaku
G
Chihara
Ruri
R
Onuma
Yoshinobu
Y
Ohtsuki
Shuji
S
Yagishita
Atsuhiko
A
Yachi
Sen
S
Nakajima
Hiroyoshi
H
Hara
Kazuhiro
K
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D054318:No-Reflow Phenomenon / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D018084:Ultrasonography, Interventional