Plaque prolapse after stent implantation in patients with acute myocardial infarction: an intravascular ultrasound analysis.
OBJECTIVE
The aim of this study was to assess the incidence, predictors, and outcome of plaque prolapse (PP) after stent implantation in acute myocardial infarction.


BACKGROUND
The imaging characteristics of PP in patients with acute myocardial infarction are not well known.


METHODS
Intravascular ultrasound (IVUS) imaging was performed in 310 patients immediately following stenting for their first acute myocardial infarction. Multiple clinical, angiographic and IVUS derived variables were compared among patients with and without intrastent PP.


RESULTS
The PP was detected in 27% of the 310 lesions examined. Stent length was longer (31 +/- 13 mm vs. 21 +/- 8 mm, p < 0.001), and positive remodeling (48% vs. 32%, p = 0.008), plaque rupture (51% vs. 31%, p = 0.001), and thrombus (40% vs. 21%, p = 0.001) were significantly more common in PP lesions compared with non-PP lesions. The creatine kinase-myocardial band (CK-MB) was significantly greater after stenting in PP lesions compared with non-PP lesions (Delta = +12.3 +/- 32.0 U/l vs. -4.9 +/- 46.1 U/l, p = 0.002). During a 1-month follow-up, the incidence of stent thrombosis was not significantly different between PP and non-PP lesions [2/85 (2.4%) vs. 2/225 (0.9%), p = 0.308]. Multivariate analysis showed that PP (odds ratio [OR]: 7.34, p < 0.001), plaque rupture (OR: 1.95, p = 0.023), and thrombus (OR: 1.84, p = 0.026) were independently associated with post-stenting CK-MB elevation, and stent length (OR: 2.39, p = 0.003), plaque rupture (OR: 1.96, p = 0.015), and positive remodeling (OR: 1.72, p = 0.044) were independently associated with the development of PP.


CONCLUSIONS
PP occurs in one-fourth of infarct-related arteries after stent implantation. Lesion characteristics such as plaque rupture and positive remodeling, together with longer stent predict PP. Although long-term follow-up is pending, PP is associated with more myonecrosis after stenting in patients with acute myocardial infarction.
Hong
Young Joon
YJ
Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute, Chonnam National University, Gwangju, Korea.
Jeong
Myung Ho
MH
Ahn
Youngkeun
Y
Sim
Doo Sun
DS
Chung
Jong Won
JW
Cho
Jung Sun
JS
Yoon
Nam Sik
NS
Yoon
Hyun Ju
HJ
Moon
Jae Youn
JY
Kim
Kye Hun
KH
Park
Hyung Wook
HW
Kim
Ju Han
JH
Cho
Jeong Gwan
JG
Park
Jong Chun
JC
Kang
Jung Chaee
JC
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D009336:Necrosis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011391:Prolapse; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012421:Rupture; D015607:Stents; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D052279:Creatine Kinase, MB Form