Abstract
BackgroundAn impaired myocardial perfusion state after primary angioplasty is a strong predictor of long-term adverse outcomes in patients with STEMI. We assessed the relationship between culprit plaque characteristics and myocardial perfusion state after primary angioplasty in patients with ST-segment elevation myocardial infarction (STEMI). MethodsA total of 101consecutive patients with de novo STEMI were divided into 3 groups according to the state of myocardial perfusion assessed by ST-segment elevation resolution (STR): Group A (complete: STR ≥70%, n=26), Group B (partial: STR<70% but ≥30%, n=55) and Group C (none: STR<30%, n=20). We analyzed plaque features by virtual histology intravascular ultrasound (VH-IVUS) and assessed the relationship between culprit plaque characteristics and STR after primary angioplasty. ResultsTotal plaque volume was significantly higher in Group C than in Groups A and B (146.4±38.0mm3vs. 93.3±29.1mm3 and 105.8±31.5mm3, p<0.001, respectively). Necrotic core (NC) volume was also significantly higher in Group C than in Groups A and B (25.4±8.0mm3, vs. 11.9±6.3mm3 and 17.3±9.7mm3, p<0.001, respectively). Analysis of receiver-operating characteristic curves revealed that total plaque volume and NC volume had the best diagnostic accuracy of all the VH-IVUS parameters to predict STR<30%. The optimal cutoff values (sensitivity/specificity) were 123.4mm3 (75.0%/75.3%) for total plaque volume and 20.3mm3 (75.0%/74.1%) for NC volume. ConclusionsCulprit plaque with large plaque burden and high NC volume is closely associated with poor STR after revascularization.
Published Version
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