Predictors of no-reflow after percutaneous coronary intervention for culprit lesion with plaque rupture in infarct-related artery in patients with acute myocardial infarction.

Abstract

BACKGROUND We investigated the predictors of the no-reflow phenomenon after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients with plaque rupture (PR). METHODS The study group comprised 112 AMI patients who underwent pre- and post-PCI intravascular ultrasound (IVUS) and stent implantation. Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2 after PCI. IVUS findings included multiple ruptured plaques (PRs separated by a >5-mm length of artery containing smooth lumen contours), thrombus (had a layered lobulated appearance, evidence of blood flow within the mass, and speckling or scintillation), and plaque prolapse (tissue extrusion through the stent struts). RESULTS Of 112 patients, no-reflow was observed in 17 patients (15.2%). High-sensitivity C-reactive protein (hs-CRP) was significantly higher (6.2+/-6.0 mg/dl vs. 2.2+/-2.9 mg/dl, p=0.002) and baseline TIMI flow grade was significantly lower in no-reflow group (TIMI flow grade<3: 59% vs. 18%, p<0.001). Lesion site plaque plus media area was significantly greater (12.9+/-2.6 mm(2) vs. 10.8+/-4.2 mm(2), p=0.009), remodeling index was significantly higher (1.14+/-0.17 vs. 1.03+/-0.20, p=0.031), and the presence of IVUS-detected thrombus (88% vs. 56%, p=0.012), culprit lesion multiple PRs (71% vs. 37%, p=0.009), and plaque prolapse (65% vs. 34%, p=0.015) were significantly more common in no-reflow group. In the multivariate analysis, plaque prolapse (OR=33.02; 95% CI 3.38-322.75, p=0.003), hs-CRP (OR=1.03; 95% CI 1.01-1.05, p=0.013), and culprit lesion multiple PRs (OR=15.73; 95% CI 1.61-153.46, p=0.018) were independent predictors of post-PCI no-reflow in AMI patients with PR. CONCLUSIONS Elevated hs-CRP and IVUS-detected multiple PRs and plaque prolapse are associated with no-reflow after PCI for PR-containing culprit lesion in infarct-related arteries in AMI patients.

DOI: 10.1016/j.jjcc.2009.03.003

Statistics

0501002011201220132014201520162017
Citations per Year

112 Citations

Semantic Scholar estimates that this publication has 112 citations based on the available data.

See our FAQ for additional information.

Cite this paper

@article{Hong2009PredictorsON, title={Predictors of no-reflow after percutaneous coronary intervention for culprit lesion with plaque rupture in infarct-related artery in patients with acute myocardial infarction.}, author={Young Joon Hong and Myung Ho Jeong and Yun Ha Choi and Jum Suk Ko and Min Goo Lee and Won Yu Kang and Shin Eun Lee and Soo Hyun Kim and Keun Ho Park and Doo Sun Sim and Nam Sik Yoon and Hyun Ju Youn and Kye Hun Kim and Hyung Wook Park and Ju Han Kim and Youngkeun Ahn and Jeong Gwan Cho and Jong Chun Park and Jung Chaee Kang}, journal={Journal of cardiology}, year={2009}, volume={54 1}, pages={36-44} }