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CLINICAL RESEARCH: ACUTE MYOCARDIAL INFARCTION

Impact of Plaque Rupture on Infarct Size in ST-Segment Elevation Anterior Acute Myocardial Infarction

Ikuyoshi Kusama, MD^_*, Kiyoshi Hibi, MD^_*,_*, Masami Kosuge, MD^_*, Naoki Nozawa, MD^_*, Hiroyuki Ozaki, MD^_*, Hideto Yano, MD^_*, Shinnichi Sumita, MD^_*, Kengo Tsukahara, MD^_*, Jun Okuda, MD^_*, Toshiaki Ebina, MD^_*, Satoshi Umemura, MD and Kazuo Kimura, MD^_*

^_* Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.

Manuscript received February 2, 2007; revised manuscript received June 6, 2007, accepted July 3, 2007.

^_* Reprint requests and correspondence: Dr. Kiyoshi Hibi, Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan. (Email: hibikiyo{at}urahp.yokohama-cu.ac.jp).

Objectives: We sought to assess whether coronary plaque rupture at culprit lesions is associated with infarct size in patients with anterior acute myocardial infarction (AMI).

Background: Some patients with AMI have large infarcts despite early reperfusion. Whether culprit plaque morphology impacts infarct size or not remains unknown.

Methods: Patients who had a first anterior AMI with reperfusion within 6 hours after onset were enrolled and divided into 2 groups according to the presence or absence of plaque rupture at the culprit lesion as defined by preintervention intravascular ultrasound (IVUS): patients with rupture (n = 54) and without rupture (n = 37).

Results: Patients with plaque rupture had a higher incidence of no-reflow phenomenon (15% vs. 3%; p = 0.08) and a lower myocardial blush grade (1.5 vs. 2.3; p < 0.05) after percutaneous coronary intervention. The IVUS analysis showed that patients with plaque rupture had a higher incidence of soft plaque and positive remodeling. Peak creatine kinase levels were higher (4,707 vs. 2,309 IU/l; p < 0.0001) and left ventricular ejection fraction in the chronic phase was lower (54% vs. 63%; p < 0.01) in patients with plaque rupture. A multivariate logistic regression analysis revealed that plaque rupture and the proximal lesion site correlated with a left ventricular ejection fraction of <50% in the chronic phase (odds ratios 6.5 and 17.5, respectively; p < 0.05).

Conclusions: Plaque rupture is associated with morphologic characteristics of vulnerable lesions, as well as with larger infarcts and a higher incidence of no-reflow phenomenon, suggesting that plaque embolism contributes to the progression of myocardial damage in patients with anterior AMI.

Abbreviations and Acronyms   AMI = acute myocardial infarction   AUC = area under the curve   CK = creatine kinase   ECG = electrocardiography   IVUS = intravascular ultrasound   PCI = percutaneous coronary intervention

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