Limitation of Angiography to Identify the Culprit Plaque in Acute Myocardial Infarction With Coronary Total OcclusionUtility of Coronary Plaque Temperature Measurement to Identify the Culprit Plaque
Takuro Takumi, MD*,
Souki Lee, MD*,
Shuichi Hamasaki, MD ,*,
Kouichi Toyonaga, MD*,
Daisuke Kanda, MD*,
Keisuke Kusumoto, MD*,
Hitoshi Toda, MD*,
Toshihiro Takenaka, MD,
Masaaki Miyata, MD,
Ryuichiro Anan, MD,
Yutaka Otsuji, MD and
Chuwa Tei, MD
* Department of Cardiology, Kagoshima City Hospital, Kagoshima, Japan
Department of Cardiovascular, Respiratory, and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan.
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Figure 1 Methods to Measure the Distance Between the Tmax Site and the Occlusive or Most Stenotic Site
Methods to measure the distance between the maximal temperature (Tmax) site by the pressure/temperature (P/T) guidewire and the occlusive site by angiography in patients with left anterior descending coronary artery (LAD) total occlusion (top panel) and that between the Tmax site and the most stenotic site in patients with LAD reperfusion (bottom panel).
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Figure 2 Distance Between the Tmax Site and the Occlusive or Most Stenotic Site
Distance between the maximal temperature (Tmax) site and the occlusive or most stenotic site by angiography. In both patients with reperfusion and total occlusion, the Tmax site was significantly distal to the occlusive or most stenotic site. However, the distance between these 2 sites was significantly longer in patients with total occlusion.
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Figure 3 Distance Between the Tmax Site and the Culprit Plaque Site
The culprit plaque site by intravascular ultrasound (IVUS) coincided with both the angiographically most stenotic site and the maximal temperature (Tmax) site in patients with reperfusion (left). The culprit plaque site by IVUS was significantly more distal to the angiographic occlusive site but coincided with the Tmax site in patients with total occlusion (right). One-sample t test was used to compare differences in distance. P/T = pressure/temperature.
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Figure 4 Representatives of Coronary Pressure and Temperature With IVUS Images
Coronary plaque temperature and coronary pressure by the pressure/temperature guidewire and intravascular ultrasound (IVUS) images in patients with left anterior descending coronary artery (LAD) reperfusion (top panel) and total occlusion (bottom panel). Angiographically most stenotic site (A), the maximal temperature (Tmax) site (B), and the site of culprit plaque by IVUS (C) were closely located to each other (top panel). The angiographic occlusive site (D) was considerably more proximal by 9 mm, compared with both the Tmax site (E) and the site of culprit plaque by IVUS (F), and the Tmax site and the site of culprit plaque by IVUS were located close to each other (bottom panel).
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