title: Intravascular ultrasound appearance of scattered necrotic core as an index for deterioration of coronary flow during intervention in acute coronary syndrome.
abstract: In acute coronary syndrome (ACS) patients with deterioration of coronary flow during percutaneous coronary intervention (PCI), a scattered necrotic core pattern (SNC) is observed by intravascular ultrasound virtual histology (VH-IVUS). The purpose of this study was to evaluate the impact of SNC on deterioration of coronary flow during PCI in ACS. A total of 38 ACS patients were imaged using VH-IVUS before PCI. In addition to conventional definitions of thin-cap fibroatheroma by VH-IVUS (ID-TCFA), the SNC was defined as necrotic core foci with a maximum diameter of <14 pixels on a 400 × 400 VH-IVUS image in the presence of >50% plaque burden except in the ID-TCFA frame. Patients were divided into deterioration of coronary flow group (n = 15) and normal-reflow group (n = 23). The incidence of residual thrombus and plaque rupture, the external elastic membrane, plaque and fibrous volumes, the incidence of ID-TCFA and the average number of SNC per frame was significantly greater in deterioration of coronary flow group than in normal-reflow group (all parameters P < 0.05). Multivariate analysis revealed that the average number of SNC per frame was independently associated with deterioration of coronary flow in ACS patients (odds ratio 1.18, P < 0.05). In conclusion, an increased number of SNC is associated with deterioration of coronary flow during PCI in ACS patients.
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640, Japan. kenjis@yu.incl.ne.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Sakata
authors.forename: Masa-aki
authors.initials: MA
authors.lastname: Kawashiri
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Ino
authors.forename: Takao
authors.initials: T
authors.lastname: Matsubara
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Uno
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yasuda
authors.forename: Kenji
authors.initials: K
authors.lastname: Miwa
authors.forename: Honin
authors.initials: H
authors.lastname: Kanaya
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamagishi
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D000368:Aged; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000000981:diagnostic imaging; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology*; D015203:Reproducibility of Results; D018084:Ultrasonography, Interventional