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

作者：Giannopoulos Georgios^*; Pappas Loukas; Synetos Andreas; Hahalis George; Raisakis Konstantinos; Papadimitriou Charalampos; Kossyvakis Charalampos; Alexopoulos Dimitrios; Tousoulis Dimitrios; Stefanadis Christodoulos; Cleman Michael W; Deftereos Spyridon

来源：International Journal of Cardiology, 2014, 174(3): 678-682.

DOI：10.1016/j.ijcard.2014.04.211

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

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. %26lt;br%26gt;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. %26lt;br%26gt;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 %26lt; 0.001). Patients with TIMI flow grades 3 and 1-2 had similar absolute total plaque volume (152.8 +/- 59.3 mm(3) vs 147.5 +/- 92.3 mm(3); p = 0.817) and absolute necrotic core (NC) volume (31.2 +/- 13.9 mm(3) vs 33.6 +/- 23.2 mm(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 %26lt; 0.001). %26lt;br%26gt;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.

• 出版日期2014-7-1