title: Impact of attenuated plaque as detected by intravascular ultrasound on the occurrence of microvascular obstruction after percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  The aim of the study was to investigate whether intravascular ultrasound (IVUS) can predict microvascular obstruction (MVO) as detected by magnetic resonance imaging (MRI) after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  MVO occurs in a sizable proportion of patients with acute myocardial infarction despite successful PCI and results in poor clinical outcomes.
  
  
  METHODS
  We assessed infarct-related lesions in 68 patients with STEMI by using IVUS before primary PCI. All patients were examined by MRI 1 week after primary PCI.
  
  
  RESULTS
  MRI-derived MVO was seen in 23 patients (34%). In the IVUS assessment, the frequency of plaque rupture, echolucent plaque, calcification and positive remodeling, and quantitative geometric data were not different between the MVO group and the no-MVO group. Although the frequency of plaque with ultrasound attenuation was similar between the 2 groups (87% vs. 89%, p = 0.999), the maximum attenuation angle (280° [range: 215° to 360°] vs. 150° [range: 95° to 300°], p = 0.008) and attenuation length (11.3 mm [range: 7.2 to 17.8 mm] vs. 6.8 mm [range: 3.0 to 10.4 mm], p = 0.009) were significantly greater in the MVO group than the no-MVO group. Multivariable logistic regression analysis showed that attenuated plaque with a maximum attenuation angle of >180° and attenuation length of >5 mm was an independent predictor of MVO (odds ratio: 6.07, 95% confidence interval: 1.89 to 19.53, p = 0.002).
  
  
  CONCLUSIONS
  Attenuated plaque with maximum attenuation angle of >180° and attenuation length of >5 mm was associated with the occurrence of MVO after primary PCI. IVUS might to be a useful tool for risk stratification in STEMI patients undergoing primary PCI.
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Shiono
authors.forename: Takashi
authors.initials: T
authors.lastname: Kubo
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanimoto
authors.forename: Shingo
authors.initials: S
authors.lastname: Ota
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ino
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aoki
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ozaki
authors.forename: Makoto
authors.initials: M
authors.lastname: Orii
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shimamura
authors.forename: Kohei
authors.initials: K
authors.lastname: Ishibashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamano
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hirata
authors.forename: Toshio
authors.initials: T
authors.lastname: Imanishi
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: AMI; CK-MB; EEM; IVUS; LV; MRI; MVO; PCI; ST-segment elevation myocardial infarction; STEMI; TIMI; Thrombolysis In Myocardial Infarction; acute myocardial infarction; attenuated plaque; creatine kinase-myocardial band; external elastic membrane; intravascular ultrasound; left ventricular; magnetic resonance imaging; microvascular obstruction; percutaneous coronary intervention