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CLINICAL RESEARCH: STUDY WITH INTRAVASCULAR ULTRASOUND

Negative Remodeling and Calcified Plaque in Octogenarians With Acute Myocardial Infarction

An Intravascular Ultrasound Analysis

Salah-Eddine Hassani, MD^_*, Gary S. Mintz, MD, Helen S. Fong, BA^_*, Sang-Wook Kim, MD^_*, Zhenyi Xue, MS^_*, Augusto D. Pichard, MD^_*, Lowell F. Satler, MD^_*, Kenneth M. Kent, MD, PhD^_*, William O. Suddath, MD^_*, Ron Waksman, MD^_* and Neil J. Weissman, MD^_*,_*

^_* Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, Washington, DC
Cardiovascular Research Foundation, New York, New York

Manuscript received August 8, 2005; revised manuscript received November 22, 2005, accepted November 28, 2005.

^_* Reprint requests and correspondence: Dr. Neil J. Weissman, Washington Hospital Center, 100 Irving Street, NW, Suite EB 5123, Washington, DC 20010. (Email: Neil.J.Weissman{at}medstar.net).

OBJECTIVES: The goal of this study was to use intravascular ultrasound (IVUS) to compare octogenarians versus patients <65 years of age with regard to culprit lesion morphology in acute myocardial infarction (MI).

BACKGROUND: Although octogenarians represent the fastest-growing segment of our population and have a higher risk profile, they are underrepresented in therapeutic trials.

METHODS: Between 2002 and 2005, 42 octogenarians and 52 patients <65 years of age underwent pre-intervention IVUS within 2 days from onset of an MI. Qualitative and quantitative measurements were performed at the lesion site and at the proximal and distal references. Positive remodeling was defined as a remodeling index (lesion/mean reference arterial area) 1.

RESULTS: Elderly patients mostly (71%) presented with non–ST-segment elevation myocardial infarction (NSTEMI), whereas patients <65 years of age presented almost equally with ST-segment elevation myocardial infarction (STEMI) and NSTEMI (56% vs. 44%). The frequency of rupture/dissection was greater in the <65-year-old group (32% vs. 9%, p = 0.009), and culprit lesions contained more thrombus in this group (14% vs. 2%, p = 0.04). Conversely, in octogenarians, lesions were predominantly calcified (57% vs. 10%, p < 0.001) and longer (20.9 ± 7.8 mm vs. 16.6 ± 6.1 mm, p = 0.004) with less positive remodeling (19% vs. 56%, p < 0.001). On multivariant logistic regression analysis, age was the only independent predictor of calcified plaque (p = 0.02) and remodeling (p = 0.005).

CONCLUSIONS: Negative remodeling and calcified plaque with rare plaque ruptured were common in elderly people with acute MI. These findings may contribute to the difference in clinical presentation and may suggest a different pathophysiologic mechanism of MI in octogenarians.

Abbreviations and Acronyms   CSA = cross-sectional area   EEM = external elastic membrane   IVUS = intravascular ultrasound   MI = myocardial infarction   NSTEMI = non–ST-segment elevation myocardial infarction   P&M = plaque and media   STEMI = ST-segment elevation myocardial infarction

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