Abstract

Aim

Coronary slow flow (SF) is an important complication of percutaneous coronary intervention (PCI) associated with poor prognosis. The aim was to assess grey-scale intravascular ultrasound (IVUS) and virtual histology (VH-IVUS) characteristics of culprit lesion in ST-elevation myocardial infarction (STEMI).

Methods

A total of 295 consecutive patients with STEMI underwent coronary angiogram and IVUS. Following PCI, patients divided into two groups; SF (thrombolysis in myocardial infarction [TIMI] flow ≤ 2, n = 74) and normal flow (NF) (TIMI flow >2, n = 221). Coronary plaque burden and its composition in relation to SF were evaluated.

Results

On grey-scale IVUS, the plaque area (12.3 mm² vs. 11.5 mm², p = .01), plaque volume (110.7 mm³ vs. 99.8 mm³, p < .001), lesion external elastic membrane (EEM) cross-sectional area (14.9 mm² vs. 14.0 mm², p = .011) and remodelling index (1.3 vs. 1.2, p = .043) were significantly higher in SF group. On VH-IVUS, absolute fibrous volume (48.1 mm³ vs. 41.5 mm³, p ≤ .001), fibrofatty volume (23.8 mm³ vs. 18.6 mm³, p = .015), necrotic core volume (8.3 mm³ vs. 5.5 mm³, p < .001), dense calcium volume (1.2 mm³ vs. 0.6 mm³, p = .003) and thin cap fibroatheroma either single (30.1% vs. 16.1%, p < .001) or multiple (9.6% vs. 1.8%, p < .001) were higher in SF arm. In multivariable analysis, absolute necrotic core volume (odds ratio = 1.159; 95% CI 1.030–1.305, p = .015) was the only independent predictor of SF.

Conclusions

Higher necrotic core volume as detected by VH-IVUS may be a potential risk factor for the development of coronary SF phenomenon in patients with STEMI after PCI.

中文翻译：

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斑块负荷和成分对ST段抬高型心肌梗死经皮冠状动脉介入治疗冠状动脉慢血流的影响：血管内超声和虚拟组织学分析

摘要

目标

冠状动脉慢血流（SF）是经皮冠状动脉介入治疗（PCI）的重要并发症，与预后不良有关。目的是评估 ST 段抬高型心肌梗死 (STEMI) 罪犯病变的灰度血管内超声 (IVUS) 和虚拟组织学 (VH-IVUS) 特征。

方法

共有 295 名连续 STEMI 患者接受了冠状动脉造影和 IVUS。PCI后，患者分为两组；SF（心肌梗死溶栓 [TIMI] 流量 ≤ 2，n  = 74）和正常流量（NF）（TIMI 流量 >2，n  = 221）。评估了与 SF 相关的冠状动脉斑块负荷及其组成。

结果

在灰度 IVUS 上，斑块面积（12.3 mm ² vs. 11.5 mm ²，p  = .01），斑块体积（110.7 mm ³ vs. 99.8 mm ³，p  < .001），病变外弹性膜（EEM） SF 组的横截面积（14.9 mm ² 对14.0 mm ²，p  = .011）和重塑指数（1.3对1.2，p  = .043）显着更高。在 VH-IVUS 上，绝对纤维体积（48.1 mm ³ vs. 41.5 mm ³，p  ≤ .001），纤维脂肪体积（23.8 mm ³ vs. 18.6 mm ³ , p  = .015), 坏死核心体积 (8.3 mm ³ vs. 5.5 mm ³ , p  < .001), 致密钙体积 (1.2 mm ³ vs. 0.6 mm ³ , p  = .003) 和薄帽在 SF 组中，单发（30.1%对16.1%，p  < .001）或多发（9.6%对1.8%，p  < .001）纤维粥样斑块均较高。在多变量分析中，绝对坏死核心体积（优势比 = 1.159；95% CI 1.030–1.305，p  = .015）是 SF 的唯一独立预测因子。

结论

VH-IVUS 检测到较高的坏死核心体积可能是 PCI 后 STEMI 患者发生冠状动脉 SF 现象的潜在危险因素。