TY - JOUR
T1 - Plaque Prolapse After Stent Implantation in Patients With Acute Myocardial Infarction. An Intravascular Ultrasound Analysis
AU - Hong, Young Joon
AU - Jeong, Myung Ho
AU - Ahn, Youngkeun
AU - Sim, Doo Sun
AU - Chung, Jong Won
AU - Cho, Jung Sun
AU - Yoon, Nam Sik
AU - Yoon, Hyun Ju
AU - Moon, Jae Youn
AU - Kim, Kye Hun
AU - Park, Hyung Wook
AU - Kim, Ju Han
AU - Cho, Jeong Gwan
AU - Park, Jong Chun
AU - Kang, Jung Chaee
PY - 2008/7
Y1 - 2008/7
N2 - Objectives: The aim of this study was to assess the incidence, predictors, and outcome of plaque prolapse (PP) after stent implantation in acute myocardial infarction. Background: The imaging characteristics of PP in patients with acute myocardial infarction are not well known. Methods: Intravascular ultrasound (IVUS) imaging was performed in 310 patients immediately following stenting for their first acute myocardial infarction. Multiple clinical, angiographic and IVUS derived variables were compared among patients with and without intrastent PP. Results: The PP was detected in 27% of the 310 lesions examined. Stent length was longer (31 ± 13 mm vs. 21 ± 8 mm, p < 0.001), and positive remodeling (48% vs. 32%, p = 0.008), plaque rupture (51% vs. 31%, p = 0.001), and thrombus (40% vs. 21%, p = 0.001) were significantly more common in PP lesions compared with non-PP lesions. The creatine kinase-myocardial band (CK-MB) was significantly greater after stenting in PP lesions compared with non-PP lesions (Δ = +12.3 ± 32.0 U/l vs. -4.9 ± 46.1 U/l, p = 0.002). During a 1-month follow-up, the incidence of stent thrombosis was not significantly different between PP and non-PP lesions [2/85 (2.4%) vs. 2/225 (0.9%), p = 0.308]. Multivariate analysis showed that PP (odds ratio [OR]: 7.34, p < 0.001), plaque rupture (OR: 1.95, p = 0.023), and thrombus (OR: 1.84, p = 0.026) were independently associated with post-stenting CK-MB elevation, and stent length (OR: 2.39, p = 0.003), plaque rupture (OR: 1.96, p = 0.015), and positive remodeling (OR: 1.72, p = 0.044) were independently associated with the development of PP. Conclusions: PP occurs in one-fourth of infarct-related arteries after stent implantation. Lesion characteristics such as plaque rupture and positive remodeling, together with longer stent predict PP. Although long-term follow-up is pending, PP is associated with more myonecrosis after stenting in patients with acute myocardial infarction.
AB - Objectives: The aim of this study was to assess the incidence, predictors, and outcome of plaque prolapse (PP) after stent implantation in acute myocardial infarction. Background: The imaging characteristics of PP in patients with acute myocardial infarction are not well known. Methods: Intravascular ultrasound (IVUS) imaging was performed in 310 patients immediately following stenting for their first acute myocardial infarction. Multiple clinical, angiographic and IVUS derived variables were compared among patients with and without intrastent PP. Results: The PP was detected in 27% of the 310 lesions examined. Stent length was longer (31 ± 13 mm vs. 21 ± 8 mm, p < 0.001), and positive remodeling (48% vs. 32%, p = 0.008), plaque rupture (51% vs. 31%, p = 0.001), and thrombus (40% vs. 21%, p = 0.001) were significantly more common in PP lesions compared with non-PP lesions. The creatine kinase-myocardial band (CK-MB) was significantly greater after stenting in PP lesions compared with non-PP lesions (Δ = +12.3 ± 32.0 U/l vs. -4.9 ± 46.1 U/l, p = 0.002). During a 1-month follow-up, the incidence of stent thrombosis was not significantly different between PP and non-PP lesions [2/85 (2.4%) vs. 2/225 (0.9%), p = 0.308]. Multivariate analysis showed that PP (odds ratio [OR]: 7.34, p < 0.001), plaque rupture (OR: 1.95, p = 0.023), and thrombus (OR: 1.84, p = 0.026) were independently associated with post-stenting CK-MB elevation, and stent length (OR: 2.39, p = 0.003), plaque rupture (OR: 1.96, p = 0.015), and positive remodeling (OR: 1.72, p = 0.044) were independently associated with the development of PP. Conclusions: PP occurs in one-fourth of infarct-related arteries after stent implantation. Lesion characteristics such as plaque rupture and positive remodeling, together with longer stent predict PP. Although long-term follow-up is pending, PP is associated with more myonecrosis after stenting in patients with acute myocardial infarction.
KW - angioplasty
KW - myocardial infarction
KW - ultrasonics
UR - http://www.scopus.com/inward/record.url?scp=47349103014&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2008.04.004
DO - 10.1016/j.jcmg.2008.04.004
M3 - Article
C2 - 19356472
AN - SCOPUS:47349103014
SN - 1936-878X
VL - 1
SP - 489
EP - 497
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 4
ER -