title: A simple and rapid method for identification of lesions at high risk for the no-reflow phenomenon immediately before elective coronary stent implantation.
abstract: We aimed to design a rapid and reliable method to identify coronary lesions at high risk for the no-reflow phenomenon before elective coronary stent implantation using integrated backscatter intravascular ultrasound (IB-IVUS). The no-reflow phenomenon occurring during elective percutaneous coronary intervention (PCI) worsens patient prognosis, regardless of whether the phenomenon is transient or persistent. We retrospectively studied 353 coronary lesions to identify factors potentially promoting the no-reflow phenomenon, including lesion location and severity. We also performed component analysis by two- and three-dimensional IB-IVUS before elective stent implantation. The cutoff values of the true lipid volume and estimated lipid volume (lipid area at the minimal lumen diameter site × total stent length) for the no-reflow phenomenon were determined by receiver operating curve analysis. Type C lesions, regardless of location and a thrombolysis in myocardial flow grade of 0, were risk factors for the no-reflow phenomenon during PCI. The estimated lipid volume was significantly correlated with the true lipid volume (R2= 0.778, p < 0.0001). The cutoff value of the estimated lipid volume for the no-reflow phenomenon was 132.6 mm3(area under the curve = 0.719), and the predictive value was equivalent to that of the true lipid volume. Lesions with an estimated lipid volume of ≥132.6 mm3had a significantly higher risk of the no-reflow phenomenon during elective stent implantation (odds ratio, 4.35; 95 % confidence interval, 1.67-12.7; p = 0.0024). The simple and rapid measurement of the estimated lipid volume immediately before stenting during PCI constitutes a reliable predictor of lesions at high risk for the no-reflow phenomenon.
authors.affiliation: Department of Cardiology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan.|Department of Cardiovascular Medicine, Tohoku University, Sendai, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Suda
authors.affiliation: Department of Cardiology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan. nami@openhp.or.jp.
authors.forename: Shigeto
authors.identifier: http://orcid.org/0000-0002-2368-9897
authors.initials: S
authors.lastname: Namiuchi
authors.affiliation: Department of Cardiology, Tsuyama Chuo Hospital, Tsuyama, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kawaguchi
authors.affiliation: Department of Cardiology, Iwaki Kyoritsu General Hospital, Iwaki, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Nihei
authors.affiliation: Department of Cardiology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Takii
authors.affiliation: Department of Cardiology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan.
authors.forename: Kenya
authors.initials: K
authors.lastname: Saji
authors.affiliation: Department of Cardiology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Sugie
authors.affiliation: Department of Cardiology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kato
authors.affiliation: Department of Cardiovascular Medicine, Tohoku University, Sendai, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimokawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008055:Lipids / Q000032:analysis; D008297:Male; D008875:Middle Aged; D054318:No-Reflow Phenomenon / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation*; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012542:Scattering, Radiation; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D008055:Lipids
keywords: Elective percutaneous coronary intervention; Integrated backscatter intravascular ultrasound; Lipid-rich plaque; No-reflow phenomenon