Abstract 9489: Clinical Impact of Integrated Backscatter Intravascular Ultrasound (IB-IVUS) Analysis for Predicting Coronary No-Reflow Phenomenon After Percutaneous Coronary Intervention

Abstract

Background and Aims Coronary no-reflow phenomenon after percutaneous coronary intervention (PCI) is associated with a poor prognosis. It is important to predict and prevent coronary no-reflow after PCI and to use distal protection device appropriately. Previous studies showed that integrated backscatter intravascular ultrasound (IB-IVUS) provided high diagnostic accuracy for tissue characterization of coronary plaques based on histology. The purpose of this study was to investigate the relationship between plaque components assessed by IB-IVUS and coronary no-reflow after PCI. Result The 177 lesions (acute coronary syndrome (ACS), n=69; non-ACS, n=108) in 168 consecutive patients (mean age 69 ± 11 years old) who received PCI using IB-IVUS were enrolled. No-reflow, including transient filter no-reflow by using distal protection device, was observed in 18 ACS lesion (26%) and 12 non-ACS lesion (11%). In both ACS and non-ACS patients, lipid volume at stent deployment lesion, lipid area at minimum lumen site (MLS) and percentage of lipid area (%Lipid) at MLS were significantly larger in no-reflow group compared with the normal-reflow group. A receiver operating characteristic (ROC) analysis was performed to assess lipid volume, lipid area at MLS and %Lipid at MLS to predict coronary no-reflow. In ACS patients, the cut-off values for lipid volume, lipid area at MLS and %Lipid at MLS were determined by ROC analysis as 97mm 3 , 7.2mm 2 and 62%, respectively. Otherwise, in non-ACS patients, the cut-off values for lipid volume, lipid area at MLS and %Lipid at MLS were determined as 93mm 3 , 6.1mm 2 and 64%, respectively. Conclusion Our present study suggests that lipid rich plaque assessed by IB-IVUS should be considered as one of important predictors of coronary no reflow after PCI. These cut-off values determined by present IB-IVUS study could improve our approach to coronary no reflow risk stratification in patients with coronary artery disease.