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ACUTE MYOCARDIAL INFARCTION: CLINICAL RESEARCH

The decrease of plaque volume during percutaneous coronary intervention has a negative impact on coronary flow in acute myocardial infarction

A major role of percutaneous coronary intervention-induced embolization

Hiroshi Sato, MD^*,*, Hidetaka Iida, MD^*, Atsushi Tanaka, MD, Hidemasa Tanaka, MD^*, Shinichi Shimodouzono, MD^*, Eiji Uchida, MD^*, Takahiko Kawarabayashi, MD and Junichi Yoshikawa, MD

^* Tsukazaki Memorial Hospital, Himeji, Japan
Baba Memorial Hospital, Sakai, Japan
Department of Internal Medicine and Cardiology, Graduate School of Medicine, Osaka City University, Osaka, Japan

Manuscript received November 6, 2003; revised manuscript received April 1, 2004, accepted April 6, 2004.

^* Reprint requests and correspondence: Dr. Hiroshi Sato, Department of Cardiology, Tsukazaki Memorial Hospital, 1-5-5, Minami-kurumazaki, Himeji, 670-0053 Japan.
sato{at}tsukazaki.or.jp

OBJECTIVES: The aim of this study was to evaluate how decreased plaque volume during percutaneous coronary intervention (PCI) affects coronary flow in patients with acute myocardial infarction (AMI).

BACKGROUND: Coronary flow after reperfusion therapy is a major determinant of clinical outcomes in patients with AMI. However, little is still known about the changes in coronary flow that appear after PCI in response to the decreased plaque during the procedure.

METHODS: The study group comprised 60 patients with AMI who underwent pre- and post-PCI intravascular ultrasound (IVUS). Qualitative and quantitative analyses were performed on all IVUS procedures. External elastic membrane volume (EEMV), lumen volume (LV), and plaque volume (PV) were measured every 1.0 mm to include the lesion and reference segments 3.0 mm proximal and distal to the lesion. The difference between pre- and post-PCI PV was defined as the index of the decrease in plaque volume (PV). The corrected TIMI frame count (CTFC) was used to evaluate coronary flow after PCI.

RESULTS: Plaque volume was decreased at post-PCI IVUS in all 60 patients. Inadequate reflow (CTFC >40) was observed in 13 patients (21.7%). The decrease in PV was significantly larger in patients with inadequate reflow than in those with reflow (49.4 ± 18.9 vs. 31.7 ± 15.5 mm³, p = 0.0010). Also, PV was significantly correlated with CTFC after PCI (r = 0.415, p = 0.0012).

CONCLUSIONS: The decrease in PV during PCI has a negative impact on coronary flow after PCI in patients with AMI. Embolization induced by PCI may occur in all patients with AMI.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CK-MB = creatine kinase-MB fraction   CTFC = corrected TIMI frame count   EEM-CSA = external elastic membrane cross-sectional area   EEMV = external elastic membrane volume   IVUS = intravascular ultrasound   L-CSA = lumen cross-sectional area   LV = lumen volume   PCI = percutaneous coronary intervention   PV = plaque volume   TIMI = Thrombolysis In Myocardial Infarction

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