title: Impact of ultrasound attenuation and plaque rupture as detected by intravascular ultrasound on the incidence of no-reflow phenomenon after percutaneous coronary intervention in ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  The aim of this study was to assess whether ultrasound attenuation and plaque rupture as detected by intravascular ultrasound (IVUS) are associated with the incidence of no-reflow phenomenon after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  No-reflow phenomenon is associated with worse long-term outcomes after STEMI. Therefore, reliable and feasible intravascular imaging techniques are needed to identify patient subgroups that would be at high risk for no-reflow phenomenon.
  
  
  METHODS
  One hundred seventy consecutive patients with STEMI who underwent PCI within 12 h after symptom onset were enrolled. The IVUS interrogation was performed before PCI.
  
  
  RESULTS
  No-reflow phenomenon occurred in 30 patients (18%), who had a higher incidence of no ST-segment resolution (50% vs. 9%; p < 0.001), a higher peak creatine kinase level (4,090 IU/l vs. 2,823 IU/l; p < 0.001), and a lower left ventricular ejection fraction in the chronic phase (51% vs. 59%; p < 0.01). Multivariate logistic regression analysis revealed that ultrasound attenuation with a longitudinal length of > or =5 mm, plaque rupture, and reperfusion time correlated with no-reflow phenomenon (all p < 0.05). In patients with both ultrasound attenuation > or =5 mm and plaque rupture, the incidence of no-reflow phenomenon was 88%, and the risk of decreased coronary reflow was higher than that predicted by either factor alone (p = 0.004 for interaction).
  
  
  CONCLUSIONS
  In patients with STEMI, a longer ultrasound attenuation and plaque rupture on IVUS are associated with an increased incidence of no-reflow phenomenon, suggesting that this subset of patients might be at high risk for distal embolism.
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Endo
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hibi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Shimizu
authors.forename: Naohiro
authors.initials: N
authors.lastname: Komura
authors.forename: Ikuyoshi
authors.initials: I
authors.lastname: Kusama
authors.forename: Fumiyuki
authors.initials: F
authors.lastname: Otsuka
authors.forename: Takayuki
authors.initials: T
authors.lastname: Mitsuhashi
authors.forename: Noriaki
authors.initials: N
authors.lastname: Iwahashi
authors.forename: Jun
authors.initials: J
authors.lastname: Okuda
authors.forename: Kengo
authors.initials: K
authors.lastname: Tsukahara
authors.forename: Masami
authors.initials: M
authors.lastname: Kosuge
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ebina
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000000981:diagnostic imaging / Q000209:etiology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012421:Rupture; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D016277:Ventricular Function, Left