title: Morphological predictors for no reflow phenomenon after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction caused by plaque rupture.
abstract: OBJECTIVE
  Myocardial no reflow after percutaneous coronary intervention (PCI) is associated with poor outcome. Patients with ST-segment elevation myocardial infarction (STEMI) caused by plaque rupture are at high risk for no reflow. However, specific morphologic characteristics associated with no reflow are unknown in this population. The aim of this study is to identify the morphological characteristics of culprit plaques associated with no reflow in patients with STEMI caused by plaque rupture using both optical coherence tomography (OCT) and intravascular ultrasound (IVUS).
  
  
  RESULTS
  We enrolled 145 patients with STEMI who underwent both OCT and IVUS within 12 h of symptom onset. Among these patients, we excluded those with plaque erosion and calcified nodule and included 72 patients who had plaque rupture as an underlying mechanism for STEMI. Myocardial no reflow, defined as Thrombolysis in Myocardial Infarction flow grade 0-2 and/or myocardial blush grade 0-1 after PCI, was observed in 28 patients (38.9%). Onset to recanalization time was similar between the groups with and without no reflow. Receiver-operating curve analysis revealed OCT-derived lipid index > 3500 [area under curve (AUC) 0.77, P < 0.001] and IVUS-derived plaque burden > 81.5% (AUC 0.70, P = 0.002) were the best discriminators for myocardial no reflow.
  
  
  CONCLUSIONS
  No reflow occurred in nearly 40% of patients with STEMI caused by plaque rupture. Large lipid index and plaque burden were critical morphological discriminators between no reflow and normal flow.
authors.affiliation: Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Higuma
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Abe
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yokoyama
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Shibutani
authors.affiliation: Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Ong
authors.affiliation: Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Rocco
authors.initials: R
authors.lastname: Vergallo
authors.affiliation: Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Minami
authors.affiliation: Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
authors.affiliation: Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA ijang@mgh.harvard.edu.|Division of Cardiology, Kyung Hee University, Seoul, South Korea.
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000000981:diagnostic imaging* / Q000401:mortality; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D054318:No-Reflow Phenomenon / Q000000981:diagnostic imaging*; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000401:mortality; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000473:pathology; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D041623:Tomography, Optical Coherence / Q000379:methods; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods
keywords: ST-segment elevation myocardial infarction; no reflow; optical coherence tomography; plaque rupture