Heart Center of Chonnam National University Hospital, Gwangju, South Korea.
Am J Cardiol. 2012 Nov 1;110(9):1290-5. doi: 10.1016/j.amjcard.2012.06.031. Epub 2012 Jul 25.
We assessed the plaque characteristics and postpercutaneous coronary intervention (PCI) outcome according to the remodeling pattern (positive remodeling [PR], n = 113; and intermediate/negative remodeling [IR/NR], n = 198) in 311 saphenous vein graft lesions using intravascular ultrasound. The remodeling index was the ratio of the lesion site saphenous vein graft area to the mean of the proximal and distal references (PR/remodeling index >1.05, IR 0.95 to 1.05, and NR <0.95). Tissue prolapse was defined as tissue extrusion through the stent strut after PCI, and the tissue prolapse volume was calculated by subtracting the lumen volume from the stent volume. The presence of hypoechoic plaque (59% vs 36%, p = 0.001), plaque rupture (26% vs 16%, p = 0.042), multiple plaque rupture (12% vs 5%, p = 0.020), and an intraluminal mass (59% vs 41%, p = 0.002) were more common in the PR lesions than in the IR/NR lesions. The plaque cavity area was significantly greater in the PR lesions than in the IR/NR lesions (0.83 ± 1.43 mm(2) vs 0.42 ± 1.07 mm(2), p = 0.009). Post-PCI no-reflow (19% vs 9%, p = 0.019) and post-PCI tissue prolapse (53% vs 27%, p <0.001) were observed more frequently, and the tissue prolapse volume was significantly greater after PCI for PR lesions than for IR/NR lesions (0.86 ± 1.30 mm(3) vs 0.34 ± 0.74 mm(3), p <0.001). PR was the independent predictor of post-PCI no-reflow (odds ratio 2.58, 95% confidence interval 1.25 to 5.64, p = 0.040) and post-PCI tissue prolapse (odds ratio 2.45, 95% confidence interval 1.46 to 5.41, p = 0.045). In conclusion, saphenous vein graft lesions with PR have vulnerable plaque and are associated with no-reflow and tissue prolapse after PCI.
我们使用血管内超声评估了 311 例大隐静脉移植病变的斑块特征和经皮冠状动脉介入治疗（PCI）后的结果，根据重塑模式（正性重塑[PR]，n=113；中间/负性重塑[IR/NR]，n=198）。重塑指数为病变部位大隐静脉移植物面积与近端和远端参考平均值的比值（PR/重塑指数>1.05，IR 0.95 至 1.05，NR<0.95）。组织脱垂定义为 PCI 后组织通过支架支柱挤出，通过从支架体积中减去管腔体积来计算组织脱垂体积。在 PR 病变中，低回声斑块（59% vs 36%，p=0.001）、斑块破裂（26% vs 16%，p=0.042）、多发斑块破裂（12% vs 5%，p=0.020）和腔内肿块（59% vs 41%，p=0.002）更为常见。PR 病变的斑块腔面积明显大于 IR/NR 病变（0.83±1.43 mm² vs 0.42±1.07 mm²，p=0.009）。PR 病变 PCI 后无再流（19% vs 9%，p=0.019）和 PCI 后组织脱垂（53% vs 27%，p<0.001）更为常见，PR 病变 PCI 后的组织脱垂体积明显大于 IR/NR 病变（0.86±1.30 mm³ vs 0.34±0.74 mm³，p<0.001）。PR 是 PCI 后无再流（优势比 2.58，95%置信区间 1.25 至 5.64，p=0.040）和 PCI 后组织脱垂（优势比 2.45，95%置信区间 1.46 至 5.41，p=0.045）的独立预测因子。总之，PR 大隐静脉移植病变有易损斑块，与 PCI 后无再流和组织脱垂有关。
