title: Association of nonculprit plaque characteristics with transient slow flow phenomenon during percutaneous coronary intervention.
abstract: BACKGROUND
  The slow flow (SF) phenomenon is more prevalent in patients with acute coronary syndrome (ACS), who frequently exhibit vulnerable plaques in remote coronary arteries. We aimed to clarify the impact of nonculprit plaque characteristics on the occurrence of SF using multidetector computed tomography (MDCT).
  
  
  METHODS
  The study population comprised 180 consecutive patients with non-ST-segment elevation ACS (NSTE-ACS) who underwent MDCT before intervention. The characteristics of culprit and nonculprit lesions were compared between patients with and without SF.
  
  
  RESULTS
  SF was observed in 43 (23.8%) of the 180 patients. The prevalence of positive remodeling (PR), low-attenuation plaque (LAP), and napkin-ring sign (NRS) in culprit lesion was significantly higher in the SF group than in the non-SF group (86.1% vs. 39.4%; p<0.001, 81.4% vs. 18.3%; p<0.001, and 65.1% vs. 16.1%; p<0.001, respectively). The same result was observed for nonculprit lesions (58.1% vs. 14.6%; p<0.001, 45.2% vs. 6.6%; p<0.001, and 14.3% vs. 4.9%; p<0.04, respectively). Multivariate analysis revealed LAP [odds ratio (OR), 12.8; 95% confidence interval (CI), 3.7-54.7; p<0.001], and NRS (OR, 5.1; 95% CI, 1.3-25.3; p=0.03) in culprit lesions and PR (OR, 4.7; 95% CI, 1.1-22.2; p=0.04) in nonculprit lesions were independently associated with SF.
  
  
  CONCLUSIONS
  The plaque characteristics of nonculprit lesions are associated with the occurrence of SF during percutaneous coronary intervention. Assessment of plaque characteristics of both culprit and nonculprit lesions using MDCT may be useful for the prediction of SF.
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan. Electronic address: kmiura06@gmail.com.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Miura
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Dote
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Kagawa
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Nakano
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Oda
authors.affiliation: Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Shota
authors.initials: S
authors.lastname: Sasaki
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D054318:No-Reflow Phenomenon / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis
keywords: Coronary CT angiography; Coronary artery disease; Interventional cardiology; Non-ST elevation acute coronary syndrome; Slow flow phenomenon