Predictors of no-reflow after percutaneous coronary intervention for culprit lesion with plaque rupture in infarct-related artery in patients with acute myocardial infarction.
BACKGROUND
We investigated the predictors of the no-reflow phenomenon after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients with plaque rupture (PR).


METHODS
The study group comprised 112 AMI patients who underwent pre- and post-PCI intravascular ultrasound (IVUS) and stent implantation. Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2 after PCI. IVUS findings included multiple ruptured plaques (PRs separated by a >5-mm length of artery containing smooth lumen contours), thrombus (had a layered lobulated appearance, evidence of blood flow within the mass, and speckling or scintillation), and plaque prolapse (tissue extrusion through the stent struts).


RESULTS
Of 112 patients, no-reflow was observed in 17 patients (15.2%). High-sensitivity C-reactive protein (hs-CRP) was significantly higher (6.2+/-6.0 mg/dl vs. 2.2+/-2.9 mg/dl, p=0.002) and baseline TIMI flow grade was significantly lower in no-reflow group (TIMI flow grade<3: 59% vs. 18%, p<0.001). Lesion site plaque plus media area was significantly greater (12.9+/-2.6 mm(2) vs. 10.8+/-4.2 mm(2), p=0.009), remodeling index was significantly higher (1.14+/-0.17 vs. 1.03+/-0.20, p=0.031), and the presence of IVUS-detected thrombus (88% vs. 56%, p=0.012), culprit lesion multiple PRs (71% vs. 37%, p=0.009), and plaque prolapse (65% vs. 34%, p=0.015) were significantly more common in no-reflow group. In the multivariate analysis, plaque prolapse (OR=33.02; 95% CI 3.38-322.75, p=0.003), hs-CRP (OR=1.03; 95% CI 1.01-1.05, p=0.013), and culprit lesion multiple PRs (OR=15.73; 95% CI 1.61-153.46, p=0.018) were independent predictors of post-PCI no-reflow in AMI patients with PR.


CONCLUSIONS
Elevated hs-CRP and IVUS-detected multiple PRs and plaque prolapse are associated with no-reflow after PCI for PR-containing culprit lesion in infarct-related arteries in AMI patients.
Hong
Young Joon
YJ
Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Republic of Korea.
Jeong
Myung Ho
MH
Choi
Yun Ha
YH
Ko
Jum Suk
JS
Lee
Min Goo
MG
Kang
Won Yu
WY
Lee
Shin Eun
SE
Kim
Soo Hyun
SH
Park
Keun Ho
KH
Sim
Doo Sun
DS
Yoon
Nam Sik
NS
Youn
Hyun Ju
HJ
Kim
Kye Hun
KH
Park
Hyung Wook
HW
Kim
Ju Han
JH
Ahn
Youngkeun
Y
Cho
Jeong Gwan
JG
Park
Jong Chun
JC
Kang
Jung Chaee
JC
D002097:C-Reactive Protein / Q000032:analysis; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000175:diagnosis*; D015607:Stents; D018084:Ultrasonography, Interventional
D002097:C-Reactive Protein