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Int J Cardiol. 2014 Jul 1;174(3):678-82. doi: 10.1016/j.ijcard.2014.04.211. Epub 2014 Apr 26.

Association of virtual histology characteristics of the culprit plaque with post-fibrinolysis flow restoration in ST-elevation myocardial infarction.

Author information

  • 1Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece; Hellenic Center for Disease Control and Prevention, Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA. Electronic address: ggiann@med.uoa.gr.
  • 2Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
  • 31st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
  • 4Department of Cardiology, University of Patras Medical School, Patras, Greece.
  • 5Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
  • 6Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.

Abstract

OBJECTIVES:

We sought to test the hypothesis that virtual histology characteristics of the culprit lesion in patients with ST-elevation myocardial infarction are associated with blood flow restoration after thrombolysis.

METHODS:

Consecutive patients referred for coronary angiography after successful thrombolysis were included in this correlational cross-sectional study. Evaluation with intravascular ultrasound (IVUS) and virtual histology of the culprit arterial segment was performed in all cases.

RESULTS:

Forty-eight patients (60.5 ± 10.7 years) were included. TIMI flow grade 3 was found in 24 (50%). Diabetes was strongly associated with lower TIMI flow 3 rate (26.7% vs 60.6%; p = 0.029) and there was a significant difference in the time to thrombolysis (2.0 ± 0.8 hours in those with TIMI flow 3 vs 3.0 ± 0.7 hours in TIMI flow grades 1-2; p < 0.001). Patients with TIMI flow grades 3 and 1-2 had similar absolute total plaque volume (152.8 ± 59.3mm(3) vs 147.5 ± 92.3mm(3); p = 0.817) and absolute necrotic core (NC) volume (31.2 ± 13.9 mm(3) vs 33.6 ± 23.2mm(3); p = 0.671). However, there were significant differences in the relative NC content, both in proportion to the whole plaque volume (26.3% vs 29.9%; p = 0.016) and as an area fraction at the largest NC site (31.5% vs 40.3%; p < 0.001).

CONCLUSION:

The NC content of atherosclerotic plaques is meaningful for flow restoration after the occurrence of a coronary event. This finding highlights the importance of plaque composition, as studied with virtual histology, not only for the sequence of processes leading to an acute plaque-related event, but also for thrombus formation and lysis, following the occurrence of such an event.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS:

STEMI; TIMI flow grade; intravascular ultrasound; radiofrequency backscatter analysis; thrombolysis; virtual histology

PMID:
24809918
[PubMed - indexed for MEDLINE]
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