Relationship between plaque composition and no-reflow phenomenon following primary angioplasty in patients with ST-segment elevation myocardial infarction--analysis with virtual histology intravascular ultrasound.
BACKGROUND
The angiographic no-reflow phenomenon after primary percutaneous coronary intervention (PCI) carries a poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). However, the type of plaque composition that associates with the angiographic no-reflow phenomenon remains unclear.


METHODS
A total of 44 patients with STEMI were enrolled in this study. After thrombectomy with an aspiration catheter, virtual histology intravascular ultrasound (VH-IVUS) of the infarct-related vessel was performed. Patients were divided into two groups according to final thrombolysis in myocardial infarction (TIMI) flow grade at the completion of PCI procedure. Complete reperfusion group (CR-group) was defined as final TIMI flow grade 3, and no-reflow group (NR-group) was defined as final TIMI flow < or = 2. The relationship between plaque composition and angiographic no-reflow phenomenon was analyzed.


RESULTS
The angiographic no-reflow phenomenon was observed in 20 individuals. The summation of the percentage of fibrofatty+necrotic core and fibrofatty+dense calcium was significantly higher in the NR-group. Receiver-operating characteristics analysis revealed that the summation of the volume and percentage of fibrofatty+necrotic core (> 20.1 mm(3), 26.2%) and fibrofatty+dense calcium (> 20.0 mm(3), 22.6%) predict the angiographic no-flow phenomenon.


CONCLUSIONS
The fibrofatty-rich component with necrotic core or dense calcium derived from VH-IVUS is closely related to the angiographic no-reflow phenomenon observed in primary PCI.
Division of Cardiology, Uwajima City Hospital, 1-1 Goten-machi, Uwajima, 798-8510, Ehime, Japan. okousei@yahoo.co.jp
Kousei
K
Ohshima
Shuntaro
S
Ikeda
Kouki
K
Watanabe
Kenichi
K
Yamane
Naoki
N
Izumi
Ken
K
Ishibashi
Kiyotaka
K
Ohshima
Mareomi
M
Hamada
D017130:Angioplasty; D002114:Calcinosis; D009202:Cardiomyopathies; D017023:Coronary Angiography; D005355:Fibrosis; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D009336:Necrosis; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000473:pathology; D018084:Ultrasonography, Interventional