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VH-IVUS predicts distal embolization after PCI in STEMI patients
23 October 2007
MedWire News: Virtual Histology intravascular ultrasound (VH-IVUS) could be used to predict the risk for distal embolization in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), say Japanese researchers.
\"The major predictor of distal embolization induced by stent deployment was necrotic core volume determined by VH-IVUS,\" the authors write in the Journal of the American College of Cardiology.
Distal embolization has been reported in 9-15% of patients who undergo primary PCI for STEMI, but it is unclear which plaque characteristics cause distal embolization after stent deployment, the team explains.
Ren Kawaguchi and colleagues from the Gunma Prefectural Cardiovascular Center examined the composition of culprit plaque in 71 STEMI patients using VH-IVUS, and assessed the value of VH-IVUS to predict the risk for distal embolization after primary PCI.
VH-IVUS of the infarct-related vessel was carried out after the lesion was crossed with a guidewire and thrombectomy with an aspiration catheter had been performed. Stent deployment was conducted immediately after VH-IVUS.
Distal embolization was defined by an ST-segment re-elevation (STR) higher than 2 mm after PCI.
Electrocardiographic recordings revealed STR in 11 (15.5%) patients after stent deployment.
VH-IVUS findings showed that patients with STR had a significantly higher necrotic core volume than patients without STR (32.9 vs 20.4 mm3, p=0.04). The two groups had similar plaque volume, fibrous volume, fibro-lipid volume, dense calcium volume, lesion length, vessel diameter, and lumen diameter, however.
Receiver operating characteristic analysis of the plaque composition volume revealed that necrotic core volume significantly predicted STR after stent deployment, whereas fibrous, fibro-lipid, dense calcium, and total plaque volume did not.
The necrotic core volume best predicted STR at a cut-off value of 33.4 mm3, with a sensitivity of 81.7% and a specificity of 63.6%. In all, 26.8% of patients had a necrotic core volume higher than 33.4 mm3.
Kawaguchi et al conclude: \"VH-IVUS is a useful means of predicting the risk of distal embolization after primary stent deployment in patients with STEMI.\"
J Am Coll Cardiol 2007; 50: 1641-1646
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发表于 2007-10-27 10:07:58