title: Assessment of echo-attenuated plaque by optical coherence tomography and its impact on post-procedural creatine kinase-myocardial band elevation in elective stent implantation.
abstract: OBJECTIVE
  This study examined morphological characteristics of echo-attenuated plaques by optical coherence tomography (OCT) and evaluated their influence on creatine kinase-myocardial band (CK-MB) elevation after percutaneous coronary intervention (PCI) in patients with elective stent implantation.
  
  
  BACKGROUND
  Recent intravascular ultrasound studies have described atherosclerotic plaques with echo attenuation (EA) without associated bright echoes that are correlated with no-reflow phenomenon after PCI.
  
  
  METHODS
  We studied 135 native de novo culprit coronary lesions in 135 patients with normal pre-PCI CK-MB levels (28 with unstable angina; 107 with stable angina) who underwent intravascular ultrasound and OCT examinations before elective stent implantation. The lesions were divided into 2 groups based on the presence or absence of EA, and OCT findings were compared. We then determined predictors of post-PCI CK-MB elevation.
  
  
  RESULTS
  EA was found in 47 (34.8%) lesions and was associated with the presence of OCT-derived thin-capped fibroatheroma, ruptured plaques, greater lipid content, intravascular ultrasound-derived large reference and plaque area, lesion eccentricity, and microcalcification. Elevated CK-MB levels were observed in 36 (26.7%) lesions, and significantly more frequently in lesions with EA than without. In multivariable analysis, EA (odds ratio [OR]: 3.49; 95% confidence interval [CI]: 1.53 to 7.93; p = 0.003) and OCT-derived ruptured plaque (OR: 2.92; 95% CI: 1.21 to 7.06; p = 0.017) were independent predictors of post-PCI CK-MB elevation.
  
  
  CONCLUSIONS
  Atherosclerotic plaques with EA were associated with characteristics considered to be high risk or unstable. OCT examination showed an additive predictive value to the presence of EA for post-PCI CK-MB elevation.
authors: Department of Cardiology, Tsuchiura Kyodo Hospital, Tsuchiura, Japan.
authors: Tetsumin
authors: T
authors: Lee
authors: Tsunekazu
authors: T
authors: Kakuta
authors: Taishi
authors: T
authors: Yonetsu
authors: Kentaro
authors: K
authors: Takahashi
authors: Ginga
authors: G
authors: Yamamoto
authors: Yoshito
authors: Y
authors: Iesaka
authors: Hideomi
authors: H
authors: Fujiwara
authors: Mitsuaki
authors: M
authors: Isobe