title: Association of virtual histology characteristics of the culprit plaque with post-fibrinolysis flow restoration in ST-elevation myocardial infarction.
abstract: OBJECTIVE
  We sought to test the hypothesis that virtual histology characteristics of the culprit lesion in patients with ST-elevation myocardial infarction are associated with blood flow restoration after thrombolysis.
  
  
  METHODS
  Consecutive patients referred for coronary angiography after successful thrombolysis were included in this correlational cross-sectional study. Evaluation with intravascular ultrasound (IVUS) and virtual histology of the culprit arterial segment was performed in all cases.
  
  
  RESULTS
  Forty-eight patients (60.5 ± 10.7 years) were included. TIMI flow grade 3 was found in 24 (50%). Diabetes was strongly associated with lower TIMI flow 3 rate (26.7% vs 60.6%; p = 0.029) and there was a significant difference in the time to thrombolysis (2.0 ± 0.8 hours in those with TIMI flow 3 vs 3.0 ± 0.7 hours in TIMI flow grades 1-2; p < 0.001). Patients with TIMI flow grades 3 and 1-2 had similar absolute total plaque volume (152.8 ± 59.3mm(3) vs 147.5 ± 92.3mm(3); p = 0.817) and absolute necrotic core (NC) volume (31.2 ± 13.9 mm(3) vs 33.6 ± 23.2mm(3); p = 0.671). However, there were significant differences in the relative NC content, both in proportion to the whole plaque volume (26.3% vs 29.9%; p = 0.016) and as an area fraction at the largest NC site (31.5% vs 40.3%; p < 0.001).
  
  
  CONCLUSIONS
  The NC content of atherosclerotic plaques is meaningful for flow restoration after the occurrence of a coronary event. This finding highlights the importance of plaque composition, as studied with virtual histology, not only for the sequence of processes leading to an acute plaque-related event, but also for thrombus formation and lysis, following the occurrence of such an event.
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece; Hellenic Center for Disease Control and Prevention, Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA. Electronic address: ggiann@med.uoa.gr.
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannopoulos
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Loukas
authors.initials: L
authors.lastname: Pappas
authors.affiliation: 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Synetos
authors.affiliation: Department of Cardiology, University of Patras Medical School, Patras, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Hahalis
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Raisakis
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Papadimitriou
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Kossyvakis
authors.affiliation: Department of Cardiology, University of Patras Medical School, Patras, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.affiliation: 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
authors.affiliation: 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Cleman
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Deftereos
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D017023:Coronary Angiography / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000639:trends*
keywords: STEMI; TIMI flow grade; intravascular ultrasound; radiofrequency backscatter analysis; thrombolysis; virtual histology