P2346Releationship between coronary plaque composition and functional lesion severity in patients with stable angina pectoris
H. Takashima, A. Kurita, H. Ando, S. Sakurai, A. Suzuki, Y. Saka, H. Sawada, M. Shimoda, T. Amano
European Heart Journal
No-reflow phenomenon is one of the most serious complications during elective percutaneous coronary intervention (PCI) and causes myocardial infarction unexpectedly. Purpose: The purpose of this study is to determine the most important plaque feature in the development of no-reflow phenomenon after elective coronary stent implantation. Methods and results: We evaluated 353 atherosclerotic lesions using threedimensional integrated backscatter intravascular ultrasound (IB-IVUS) before elective
... onary stent implantation. These lesions were categorized into three groups according to the coronary blood flow after stent implantation (Group N, T, and P). Group N included 334 lesions (94.6%) without no-reflow phenomenon during elective PCI. Group T and P included 12 lesions (3.4%) with transient noreflow phenomenon and 7 lesions (2.0%) with persistent no-reflow phenomenon, respectively. We investigated patients' characteristics, angiographic findings and IB-IVUS findings. There were no significant differences about patients' backgrounds and laboratory findings among three groups. No-reflow phenomenon occurred predominantly in the most severe lesions (Type C), which represented 12%, 25%, and 57% of lesions in Group N, T, and P (p=0.014), respectively. There was no significant difference in the ratio of lipid component in target lesions (Group N/T/P: 54±15/58±17/61±13%, p=0.28). In contrast, Group T and P had larger true lipid volume significantly compared with Group N (Group N/T/P: 97±79mm 3 /166±112mm 3 /238±181mm 3 , p<0.0001). Multivariate analysis revealed that only true lipid volume in target plaque was the significant predictor for the development of no-reflow phenomenon. The odds rate for no-reflow phenomenon was 4.82 per 50mm 3 increase in lipid volume (95% confidence interval 1.72-16.0, p=0.0056). Conclusion: Lipid volume in target plaque is the only predictor for the development of no-reflow phenomenon. In Atherosclerotic plaque analysis using threedimensional IB-IVUS, quantitative evaluation is more important to estimate the risk of no-reflow phenomenon compared with qualitative evaluation.