Lipid-Core Plaque Assessed by Near-Infrared Spectroscopy and Procedure Related Microvascular Injury

Hyoung-Mo Yang; Myeong-HoYoon; Hong-Seok Lim; Kyoung-Woo Seo; Byoung-JooChoi; So-YeonChoi; Gyo-SeungHwang; Seung-Jea Tahk

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저자정보: Hyoung-Mo Yang (Ajou University School of Medicine) Myeong-HoYoon (Ajou University School of Medicine) Hong-Seok Lim (Ajou University School of Medicine) Kyoung-Woo Seo (Ajou University School of Medicine) Byoung-JooChoi (Ajou University School of Medicine) So-YeonChoi (Ajou University School of Medicine) Gyo-SeungHwang (Ajou University School of Medicine) Seung-Jea Tahk (Ajou University College of Medicine)

저널정보: 대한심장학회 Korean Circulation Journal Korean Circulation Journal Vol.49 No.11

발행연도: 2019.1

수록면: 1,010 - 1,018 (9page)

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Background and Objectives: Microvascular damage due to distal embolization during percutaneous coronary intervention (PCI) is an important cause of periprocedural myocardial infarction. We assessed the lipid-core plaque using near-infrared spectroscopy (NIRS) and microvascular dysfunction invasively with the index of microcirculatory resistance (IMR) and evaluated their relationship. Methods: This study is pilot retrospective observational study. We analyzed 39 patients who performed NIRS before and after PCI, while fractional flow reserve, thermo-dilution coronary flow reserve (CFR) and IMR were measured after PCI. The maximum value of lipid core burden index (LCBI) for any of the 4-mm segments at the culprit lesion (culprit LCBI4mm) was calculated at the culprit lesion. We divided the patients into 2 groups using a cutoff of culprit LCBI4mm ≥500. Results: Mean pre-PCI LCBI was 333±196 and mean post-PCI IMR was 20±14 U. Post-PCI IMR was higher (15.6±7.3 vs. 42.6±17.6 U, p<0.001) and post-PCI CFR was lower (3.7±2.2 vs. 2.1±1.0, p=0.029) in the high LCBI group. Pre-PCI LCBI was positively correlated with post-PCI IMR (ρ=0.358, p=0.025) and negatively correlated with post-PCI CFR (ρ=−0.494, p=0.001). The incidence of microvascular dysfunction (IMR ≥25 U) was higher in the high LCBI group (9.4% vs. 85.7%, p<0.001). However, there were no significant differences in the incidences of creatine Kinase-MB (9.4% vs. 14.3%, p=0.563) and troponin-I elevation (12.5% vs. 14.3%, p=1.000). Conclusions: A large lipid-core plaque at the ‘culprit’ lesion is observed higher incidence of post-PCI microvascular dysfunction after PCI. Prospective study with adequate subject numbers will be needed.

#Percutaneous coronary intervention #Coronary artery disease #Microvessel #Near-infrared spectroscopy

참고문헌 (28)

참고문헌 신청

Henriques JP / 2002 / Incidence and clinical significance of distal embolization during primary angioplasty for acute myocardial infarction / Eur Heart J 23:1112~1117

Prasad A / 2006 / Isolated elevation in troponin T after percutaneous coronary intervention is associated with higher long-term mortality / J Am Coll Cardiol 48:1765~1770

Claessen BE / 2012 / Plaque composition by intravascular ultrasound and distal embolization after percutaneous coronary intervention / JACC Cardiovasc Imaging 5:S111

Idris H / 2014 / Varying definitions for periprocedural myocardial infarction alter event rates and prognostic implications / J Am Heart Assoc 3:e001086

Prati F / 2003 / Stenting of culprit lesions in unstable angina leads to a marked reduction in plaque burden : a major role of plaque embolization? A serial intravascular ultrasound study / Circulation 107:2320~2325

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