Prediction of the filter no-reflow phenomenon in patients with angina pectoris by using multimodality: Magnetic resonance imaging, optical coherence tomography, and serum biomarkers.
BACKGROUND
Although the occurrence of no-reflow during percutaneous coronary intervention (PCI) has been shown to be associated with worse short- and long-term clinical outcomes, the clinical relevance of preventing flow deterioration by using the filter-based distal protection devices (DPDs) is controversial. We investigated predictors of the filter no-reflow (FNR) phenomenon during PCI by using multimodality, such as hyperintense plaques (HIPs) in the coronary artery on T1-weighted imaging (T1WI) non-contrast magnetic resonance, plaque composition by using optical coherence tomography (OCT), and serum biomarkers, in patients with angina pectoris.


RESULTS
Fifty lesions from 50 patients with angina were examined. All patients underwent T1WI within 24 h before invasive coronary angiography was performed, and preinterventional OCT was performed on a native atherosclerotic culprit lesion. The signal intensity of coronary plaque to cardiac muscle ratio (PMR) was calculated on a standard console of the magnetic resonance system. Of the 50 lesions, 20 lesions showed FNR during PCI, while non-FNR was observed in 30 lesions. A cut-off value >1.85 of PMR had a sensitivity of 65%, a specificity of 93%, a positive predictive value of 87%, and a negative predictive value of 80% for identifying lesions with FNR. Multivariate analysis revealed that the presence of HIPs with PMR >1.85 (p=0.008) was the only independent predictor of the FNR phenomenon during PCI.


CONCLUSIONS
This study shows that the presence of HIPs with PMR >1.85 on T1WI was a novel independent predictor of the FNR phenomenon during PCI in angina patients. This result may help in identifying high-risk lesions for no-reflow to deploy filter-based DPDs.
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
Kenji
K
Matsumoto
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan. Electronic address: ehara@med.osaka-cu.ac.jp.
Shoichi
S
Ehara
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
Takao
T
Hasegawa
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
Kenichiro
K
Otsuka
Nishinomiya Watanabe Cardiovascular Center, Hyogo, Japan.
Junichi
J
Yoshikawa
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
Kenei
K
Shimada
D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000150:complications*; D015415:Biomarkers / Q000097:blood; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D054318:No-Reflow Phenomenon / Q000000981:diagnostic imaging*; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence
D015415:Biomarkers
Coronary artery disease; Distal protection device; Magnetic resonance imaging; No-reflow phenomenon; Optical coherence tomography