Comparison of Coronary Arterial Finding by Intravascular Ultrasound in Patients With “Transient No-Reflow” Versus “Reflow” During Percutaneous Coronary Intervention in Acute Coronary Syndrome

Previous studies have shown that transient no-reflow during coronary intervention but with Thrombosis in Myocardial Infarction (TIMI) grade 3 flow at the completion of the procedure is associated with increased in-hospital and 6-month mortality. We hypothesized that the use of intravascular ultrasou...

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Veröffentlicht in:The American journal of cardiology 2006, Vol.97 (1), p.29-33
Hauptverfasser: Iijima, Raisuke, Shinji, Hideo, Ikeda, Nobutaka, Itaya, Hideki, Makino, Kunihiko, Funatsu, Atsushi, Yokouchi, Itaru, Komatsu, Hirotaka, Ito, Naoki, Nuruki, Hiroya, Nakajima, Rintaro, Nakamura, Masato
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container_title The American journal of cardiology
container_volume 97
creator Iijima, Raisuke
Shinji, Hideo
Ikeda, Nobutaka
Itaya, Hideki
Makino, Kunihiko
Funatsu, Atsushi
Yokouchi, Itaru
Komatsu, Hirotaka
Ito, Naoki
Nuruki, Hiroya
Nakajima, Rintaro
Nakamura, Masato
description Previous studies have shown that transient no-reflow during coronary intervention but with Thrombosis in Myocardial Infarction (TIMI) grade 3 flow at the completion of the procedure is associated with increased in-hospital and 6-month mortality. We hypothesized that the use of intravascular ultrasound before intervention could identify morphologic features that were predictive of transient no-reflow in patients who had acute coronary syndrome (ACS). We analyzed 220 patients with ACS who had suitable intravascular ultrasound images that were acquired before intervention. We defined “transient no-reflow” as TIMI grade 0, 1, or 2 flow during the procedure and TIMI grade 3 flow at the completion of the procedure. We defined “reflow” as good coronary flow (TIMI grade 3 flow) during and after the procedure. Patients were categorized to a transient no-reflow group (n = 20) or a reflow group (n = 200). In the transient no-reflow group, vessel area and amount of plaque burden in the culprit lesion were significantly greater than in the reflow group (vessel 20.8 ± 5.4 vs 16.4 ± 6.2 mm 2, p
doi_str_mv 10.1016/j.amjcard.2005.07.104
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We hypothesized that the use of intravascular ultrasound before intervention could identify morphologic features that were predictive of transient no-reflow in patients who had acute coronary syndrome (ACS). We analyzed 220 patients with ACS who had suitable intravascular ultrasound images that were acquired before intervention. We defined “transient no-reflow” as TIMI grade 0, 1, or 2 flow during the procedure and TIMI grade 3 flow at the completion of the procedure. We defined “reflow” as good coronary flow (TIMI grade 3 flow) during and after the procedure. Patients were categorized to a transient no-reflow group (n = 20) or a reflow group (n = 200). In the transient no-reflow group, vessel area and amount of plaque burden in the culprit lesion were significantly greater than in the reflow group (vessel 20.8 ± 5.4 vs 16.4 ± 6.2 mm 2, p &lt;0.01; plaque burden 0.90 ± 0.03 vs 0.83 ± 0.08, p &lt;0.001). The presence of ruptured plaque, lipid pool-like images, and thrombus formation were significantly higher in the transient no-reflow group than in the reflow group. Multivariate analysis identified the presence of thrombus formation (odds ratio 4.53, 95% confidence interval 1.03 to 20.0, p = 0.04) and larger plaque burden (odds ratio 1.79, 95% confidence interval 1.01 to 3.23, p = 0.05) as independent predictors of transient no-reflow. In conclusion, lesion morphologies are different for transient no-reflow and reflow. 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We hypothesized that the use of intravascular ultrasound before intervention could identify morphologic features that were predictive of transient no-reflow in patients who had acute coronary syndrome (ACS). We analyzed 220 patients with ACS who had suitable intravascular ultrasound images that were acquired before intervention. We defined “transient no-reflow” as TIMI grade 0, 1, or 2 flow during the procedure and TIMI grade 3 flow at the completion of the procedure. We defined “reflow” as good coronary flow (TIMI grade 3 flow) during and after the procedure. Patients were categorized to a transient no-reflow group (n = 20) or a reflow group (n = 200). In the transient no-reflow group, vessel area and amount of plaque burden in the culprit lesion were significantly greater than in the reflow group (vessel 20.8 ± 5.4 vs 16.4 ± 6.2 mm 2, p &lt;0.01; plaque burden 0.90 ± 0.03 vs 0.83 ± 0.08, p &lt;0.001). The presence of ruptured plaque, lipid pool-like images, and thrombus formation were significantly higher in the transient no-reflow group than in the reflow group. Multivariate analysis identified the presence of thrombus formation (odds ratio 4.53, 95% confidence interval 1.03 to 20.0, p = 0.04) and larger plaque burden (odds ratio 1.79, 95% confidence interval 1.01 to 3.23, p = 0.05) as independent predictors of transient no-reflow. In conclusion, lesion morphologies are different for transient no-reflow and reflow. These findings suggest that the presence of thrombus formation and large plaque burden increase the risk for developing transient no-reflow during coronary intervention for ACS.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>16377279</pmid><doi>10.1016/j.amjcard.2005.07.104</doi><tpages>5</tpages></addata></record>
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subjects Aged
Angina, Unstable - diagnostic imaging
Angina, Unstable - therapy
Angioplasty, Balloon, Coronary
Biological and medical sciences
Blood vessels
Cardiology. Vascular system
Cardiovascular disease
Comparative analysis
Coronary Artery Disease - diagnostic imaging
Coronary Circulation
Coronary heart disease
Coronary Thrombosis - diagnostic imaging
Coronary vessels
Coronary Vessels - diagnostic imaging
Creatine Kinase - blood
Female
Heart
Humans
Male
Medical sciences
Middle Aged
Multivariate Analysis
Myocardial Infarction - diagnostic imaging
Myocardial Infarction - therapy
Patients
Stents
Stroke Volume
Ultrasonic imaging
Ultrasonography, Interventional
title Comparison of Coronary Arterial Finding by Intravascular Ultrasound in Patients With “Transient No-Reflow” Versus “Reflow” During Percutaneous Coronary Intervention in Acute Coronary Syndrome
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