title: Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-ST-segment elevation acute coronary syndrome: an optical coherence tomography study.
abstract: OBJECTIVE
  Although some recent guidelines recommend an early invasive strategy for non-ST-segment elevation acute coronary syndrome (NSTEACS), several studies have failed to identify any benefit for very early intervention for NSTEACS. The no-reflow phenomenon may inhibit the expected benefit from very early recanalization for NSTEACS subjects. The aim of this study was to investigate whether optical coherence tomography (OCT) could predict no-reflow in patients with NSTEACS.
  
  
  RESULTS
  This study comprised 83 consecutive patients with NSTEACS who underwent OCT and successful emergent primary stenting. On the basis of post-stent TIMI flow, patients were divided into two groups: no-reflow group (n = 14) and reflow group (n = 69). Thin-cap fibroatheroma (TCFA) was defined as a plaque presenting lipid content for >90 degrees , and with thinnest part of the fibrous cap measuring <70 microm. Thin-cap fibroatheroma were more frequently observed in the no-reflow group than in the reflow group (50% vs. 16%, P = 0.005). The frequency of the no-reflow phenomenon increases according to the size of the lipid arc in the culprit plaque. Final TIMI blush grade also deteriorated according to the increase in the lipid arc. A multivariable logistic regression model revealed that lipid arc alone was an independent predictor of no-reflow (odds ratio 1.018; CI 1.004-1.033; P = 0.01).
  
  
  CONCLUSIONS
  Optical coherence tomography can predict no-reflow after percutaneous coronary intervention (PCI) in NSTEACS. The lipid contents of a culprit plaque may play a key role in damage to the microcirculation after PCI for NSTEACS. From our results, it is found that OCT is useful tool for stratifying risk for PCI for NSTEACS.
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera Wakayama, Japan. m4497147@msic.med.osaka-cu.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.forename: Toshio
authors.initials: T
authors.lastname: Imanishi
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.forename: Takashi
authors.initials: T
authors.lastname: Kubo
authors.forename: Shigeho
authors.initials: S
authors.lastname: Takarada
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanimoto
authors.forename: Akio
authors.initials: A
authors.lastname: Kuroi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Tsujioka
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ikejima
authors.forename: Kenichi
authors.initials: K
authors.lastname: Komukai
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kataiwa
authors.forename: Keishi
authors.initials: K
authors.lastname: Okouchi
authors.forename: Manabu
authors.initials: M
authors.lastname: Kashiwaghi
authors.forename: Kohei
authors.initials: K
authors.lastname: Ishibashi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Kazushi
authors.initials: K
authors.lastname: Takemoto
authors.forename: Nobuo
authors.initials: N
authors.lastname: Nakamura
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hirata
authors.forename: Masato
authors.initials: M
authors.lastname: Mizukoshi
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
mesh_terms: D054058:Acute Coronary Syndrome / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008055:Lipids / Q000502:physiology; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D015425:Myocardial Reperfusion; D054318:No-Reflow Phenomenon / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D015607:Stents / Q000009:adverse effects; D013318:Stroke Volume / Q000502:physiology; D041623:Tomography, Optical Coherence
chemical_list: D008055:Lipids