HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Hassani, S.-E. Articles by Weissman, N. J. Search for Related Content PubMed PubMed Citation Articles by Hassani, S.-E. Articles by Weissman, N. J.

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

This article has been cited by other articles:

				S. Motoyama, T. Kondo, M. Sarai, A. Sugiura, H. Harigaya, T. Sato, K. Inoue, M. Okumura, J. Ishii, H. Anno, et al. Multislice Computed Tomographic Characteristics of Coronary Lesions in Acute Coronary Syndromes J. Am. Coll. Cardiol., July 24, 2007; 50(4): 319 - 326. [Abstract] [Full Text] [PDF]

				L. W. Klein Atherosclerosis Regression, Vascular Remodeling, and Plaque Stabilization J. Am. Coll. Cardiol., January 16, 2007; 49(2): 271 - 273. [Full Text] [PDF]