Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, 671 Jaebongro, Dong-gu, Gwangju 501-757, Republic of Korea.
Eur Heart J. 2011 Aug;32(16):2059-66. doi: 10.1093/eurheartj/ehp034. Epub 2009 Feb 19.
We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relation between coronary plaque characteristics and no-reflow in acute coronary syndrome (ACS) patients.
A total of 190 consecutive ACS patients were imaged using VH-IVUS and analysed retrospectively. Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2 after stenting. Virtual histology-intravascular ultrasound classified the colour-coded tissue into four major components: fibrotic, fibro-fatty, dense calcium, and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (≥10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden≥40%. Of the 190 patients studied at pre-stenting, no-reflow was observed in 24 patients (12.6%) at post-stenting. The absolute and %NC areas at the minimum lumen sites (1.6±1.2 vs. 0.9±0.8 mm2, P<0.001, and 24.5±14.3 vs. 16.1±10.6%, P=0.001, respectively) and the absolute and %NC volumes (30±24 vs. 16±17 mm3, P=0.001, and 22±11 vs. 14±8%, P<0.001, respectively) were significantly greater, and the presence of at least one TCFA and multiple TCFAs within culprit lesions (71 vs. 36%, P=0.001, and 38 vs. 15%, P=0.005, respectively) was significantly more common in the no-reflow group compared with the normal-reflow group. In the multivariable analysis, %NC volume was the only independent predictor of no-reflow (odds ratio=1.126; 95% CI 1.045-1.214, P=0.002).
In ACS patients, post-stenting no-reflow is associated with plaque components defined by VH-IVUS analysis with larger NC and more TCFAs.
我们使用虚拟组织学血管内超声（VH-IVUS）评估急性冠状动脉综合征（ACS）患者冠状动脉斑块特征与无复流之间的关系。
共对 190 例连续 ACS 患者进行 VH-IVUS 成像并进行回顾性分析。支架置入后，造影无复流定义为 TIMI 血流分级 0、1 和 2 级。VH-IVUS 将彩色编码组织分为四个主要成分：纤维、纤维脂肪、致密钙和坏死核（NC）。薄帽纤维粥样斑块（TCFA）定义为局灶性、富含 NC（≥横截面面积的 10%）斑块与管腔接触，斑块负荷≥40%。在支架置入前的 190 例患者中，支架置入后 24 例（12.6%）出现无复流。最小管腔部位的绝对和%NC 面积（1.6±1.2 比 0.9±0.8mm2，P<0.001，和 24.5±14.3 比 16.1±10.6%，P=0.001）和绝对和%NC 体积（30±24 比 16±17mm3，P=0.001，和 22±11 比 14±8%，P<0.001）均显著更大，且罪犯病变中至少存在一个 TCFA 和多个 TCFA（71 比 36%，P=0.001，和 38 比 15%，P=0.005）在无复流组中更为常见。在多变量分析中，%NC 体积是无复流的唯一独立预测因子（比值比=1.126；95%CI 1.045-1.214，P=0.002）。
在 ACS 患者中，支架置入后无复流与 VH-IVUS 分析定义的斑块成分相关，其 NC 较大且 TCFA 较多。
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