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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Usefulness of Virtual Histology Intravascular Ultrasound to Predict Distal Embolization for ST-Segment Elevation Myocardial Infarction

Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.

Manuscript received March 12, 2007; revised manuscript received May 29, 2007, accepted June 4, 2007.

^_* Reprint requests and correspondence: Dr. Ren Kawaguchi, Director of Cardiology Division, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-Machi, Maebashi, Gunma 371-0004, Japan. (Email: kawaguchi.r{at}cvc.pref.gunma.jp).

Objectives: We aimed to predict the high-risk plaque of distal embolization after stent deployment in patients with acute ST-segment elevation myocardial infarction (STEMI) with Virtual Histology intravascular ultrasound (VH-IVUS) (Volcano Therapeutics, Inc., Rancho Cordova, California).

Background: Distal embolization during primary percutaneous coronary intervention (PCI) carries a poor prognosis in patients with STEMI. However, it is unclear which plaque characteristics cause distal embolization after stent deployment.

Methods: A total of 71 patients with STEMI were included prospectively. All patients underwent primary PCI within 12 h of symptom onset. After crossing the lesion with a guidewire and performing thrombectomy with an aspiration catheter, VH-IVUS of the infarct-related vessel was performed. Stent deployment was then undertaken without embolic protection. ST-segment re-elevation (STR) was used to evaluate distal embolization. Correlations among plaque characteristics, morphology, and distal embolization were analyzed.

Results: The STR after stent deployment was observed in 11 patients (STR group, 15.5%). Necrotic core volume was significantly higher in the STR group than in the non-STR group (32.9 ± 14.1 mm³ vs. 20.4 ± 19.1 mm³, p < 0.05). Total plaque volume was similar in both groups. On receiver-operating characteristic analysis, necrotic core volume clearly predicted STR after stent deployment as compared with fibrous, fibro-lipid, dense calcium, and total plaque volumes. The necrotic core volume that was best predictive for STR was 33.4 mm³, with a sensitivity of 81.7% and a specificity of 63.6%.

Conclusions: Virtual Histology IVUS is a useful means of predicting the risk of distal embolization after primary stent deployment in patients with STEMI.

Abbreviations and Acronyms   CTFC = corrected Thrombolysis In Myocardial Infarction frame count   ECG = electrocardiography   IVUS = intravascular ultrasound   PCI = percutaneous coronary intervention   ROC = receiver-operating characteristic   STEMI = ST-segment elevation myocardial infarction   STR = ST-segment re-elevation   TIMI = Thrombolysis In Myocardial Infarction   VH = Virtual Histology

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