This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2007.06.051v1 50/17/1641    most recent 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 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 (6) Citing Articles via Google Scholar Google Scholar Articles by Kawaguchi, R. Articles by Taniguchi, K. Search for Related Content PubMed PubMed Citation Articles by Kawaguchi, R. Articles by Taniguchi, K. Related Collections Related Articles

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

Related Articles

Distal Embolization After Percutaneous Coronary Interventions: Prediction, Prevention, and Relevance

Prediman K. Shah
J. Am. Coll. Cardiol. 2007 50: 1647-1648. [Full Text] [PDF]

This article has been cited by other articles:

				C. M. Gardner, H. Tan, E. L. Hull, J. B. Lisauskas, S. T. Sum, T. M. Meese, C. Jiang, S. P. Madden, J. D. Caplan, A. P. Burke, et al. Detection of Lipid Core Coronary Plaques in Autopsy Specimens With a Novel Catheter-Based Near-Infrared Spectroscopy System J. Am. Coll. Cardiol. Img., September 1, 2008; 1(5): 638 - 648. [Abstract] [Full Text] [PDF]

				F. Alfonso and L. Hernando Intravascular ultrasound tissue characterization. I like the rainbow but... what's behind the colours? Eur. Heart J., July 2, 2008; 29(14): 1701 - 1703. [Full Text] [PDF]

				T. Uetani, T. Amano, H. Ando, K. Yokoi, K. Arai, M. Kato, N. Marui, M. Nanki, T. Matsubara, H. Ishii, et al. The correlation between lipid volume in the target lesion, measured by integrated backscatter intravascular ultrasound, and post-procedural myocardial infarction in patients with elective stent implantation Eur. Heart J., July 2, 2008; 29(14): 1714 - 1720. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2355 - 2369. [Full Text] [PDF]

				R. Kawaguchi Reply J. Am. Coll. Cardiol., April 1, 2008; 51(13): 1324 - 1325. [Full Text] [PDF]

				I. Porto, L. Testa, and A. P. Banning Plaque Burden, Intravascular Ultrasound, and Distal Embolization Phenomenon J. Am. Coll. Cardiol., April 1, 2008; 51(13): 1323 - 1324. [Full Text] [PDF]

				P. K. Shah Distal Embolization After Percutaneous Coronary Interventions: Prediction, Prevention, and Relevance J. Am. Coll. Cardiol., October 23, 2007; 50(17): 1647 - 1648. [Full Text] [PDF]