title: Impact of culprit plaque volume and composition on myocardial microcirculation following primary angioplasty in patients with ST-segment elevation myocardial infarction: virtual histology intravascular ultrasound analysis.
abstract: BACKGROUND
  An impaired myocardial perfusion state after primary angioplasty is a strong predictor of long-term adverse outcomes in patients with STEMI. We assessed the relationship between culprit plaque characteristics and myocardial perfusion state after primary angioplasty in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  METHODS
  A total of 101 consecutive patients with de novo STEMI were divided into 3 groups according to the state of myocardial perfusion assessed by ST-segment elevation resolution (STR): Group A (complete: STR ≥ 70%, n=26), Group B (partial: STR<70% but ≥ 30%, n=55) and Group C (none: STR<30%, n=20). We analyzed plaque features by virtual histology intravascular ultrasound (VH-IVUS) and assessed the relationship between culprit plaque characteristics and STR after primary angioplasty.
  
  
  RESULTS
  Total plaque volume was significantly higher in Group C than in Groups A and B (146.4 ± 38.0 mm(3)vs. 93.3 ± 29.1 mm(3) and 105.8 ± 31.5 mm(3), p<0.001, respectively). Necrotic core (NC) volume was also significantly higher in Group C than in Groups A and B (25.4 ± 8.0m m(3), vs. 11.9 ± 6.3 mm(3) and 17.3 ± 9.7 mm(3), p<0.001, respectively). Analysis of receiver-operating characteristic curves revealed that total plaque volume and NC volume had the best diagnostic accuracy of all the VH-IVUS parameters to predict STR<30%. The optimal cutoff values (sensitivity/specificity) were 123.4 mm(3) (75.0%/75.3%) for total plaque volume and 20.3mm(3) (75.0%/74.1%) for NC volume.
  
  
  CONCLUSIONS
  Culprit plaque with large plaque burden and high NC volume is closely associated with poor STR after revascularization.
authors.affiliation: Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Tohon, Ehime, 791-0295, Japan. okousei@m.ehime-u.ac.jp
authors.forename: Kousei
authors.initials: K
authors.lastname: Ohshima
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Ikeda
authors.forename: Hisaki
authors.initials: H
authors.lastname: Kadota
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yamane
authors.forename: Naoki
authors.initials: N
authors.lastname: Izumi
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Ohshima
authors.forename: Mareomi
authors.initials: M
authors.lastname: Hamada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*