Coronary Plaque Characteristics Associated With Reduced TIMI (Thrombolysis in Myocardial Infarction) Flow Grade in Patients With ST-Segment-Elevation Myocardial Infarction: A Combined Optical Coherence Tomography and Intravascular Ultrasound Study.
Previous studies reported that reduced TIMI (Thrombolysis in Myocardial Infarction) flow grade before procedure was associated with worse clinical outcomes in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. The aim of this study was to identify specific morphological characteristics of the culprit plaque associated with poor TIMI flow grade at baseline in patients with ST-segment-elevation myocardial infarction using both optical coherence tomography and intravascular ultrasound.



A total of 111 ST-segment-elevation myocardial infarction patients who underwent percutaneous coronary intervention within 24 hours of symptom onset were included. Both optical coherence tomography and intravascular ultrasound were performed after thrombectomy. Patients were divided into 2 groups according to preprocedural TIMI flow grade (TIMI 0-1 [n=82] and TIMI 2-3 [n=29]). Patients with preprocedural TIMI 0 to 1 had a greater lipid arc (P=0.037), a longer lipid length (P=0.021), and a greater lipid index (P=0.007) determined by optical coherence tomography and a larger external elastic membrane cross-sectional area (P=0.030) and plaque plus media cross-sectional area (P=0.030) determined by intravascular ultrasound, compared with patients with preprocedural TIMI 2 to 3.



ST-segment-elevation myocardial infarction patients with reduced TIMI flow grade at baseline have greater lipid burden, larger vessel sizes, and larger plaque areas.
From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.).
Takumi
T
Higuma
From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.).
Tsunenari
T
Soeda
From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.).
Masahiro
M
Yamada
From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.).
Takashi
T
Yokota
From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.).
Hiroaki
H
Yokoyama
From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.).
Fumie
F
Nishizaki
From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.).
Lei
L
Xing
From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.).
Erika
E
Yamamoto
From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.).
Krzysztof
K
Bryniarski
From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.).
Jiannan
J
Dai
From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.).
Hang
H
Lee
From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.).
Ken
K
Okumura
From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.). ijang@mgh.harvard.edu.
Ik-Kyung
IK
Jang
D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; 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; D008055:Lipids / Q000032:analysis; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D066253:Vascular Remodeling
D008055:Lipids
acute coronary syndrome; coronary angiography; optical coherence tomography; percutaneous coronary intervention; vascular remodeling