Assessment of Echo-Attenuated Plaque by Optical Coherence Tomography and its Impact on Post-Procedural Creatine Kinase-Myocardial Band Elevation in Elective Stent Implantation

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• 作者：Tetsumin Lee ; MD<sup>?/sup> ; Tsunekazu Kakuta ; MD<sup>?/sup><sup> ; sup><sup>kaz@joy.email.ne.jpsup> ; Taishi Yonetsu ; MD<sup>?/sup> ; Kentaro Takahashi ; MD<sup>?/sup> ; Ginga Yamamoto ; MD<sup>?/sup> ; Yoshito Iesaka ; MD<sup>?/sup> ; Hideomi Fujiwara ; MD<sup>?/sup> ; Mitsuaki Isobe ; MD<sup>&dagger ; sup>
• 关键词：angioplasty ; imaging ; intravascular ultrasound ; optical coherence tomography
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2011
• 出版时间：May 2011
• 年：2011
• 卷：4
• 期：5
• 页码：483-491
• 全文大小：859 K

文摘

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ss=""h4"">Objectives

This study examined morphological characteristics of echo-attenuated plaques by optical coherence tomography (OCT) and evaluated their influence on creatine kinase-myocardial band (CK-MB) elevation after percutaneous coronary intervention (PCI) in patients with elective stent implantation.

ss=""h4"">Background

Recent intravascular ultrasound studies have described atherosclerotic plaques with echo attenuation (EA) without associated bright echoes that are correlated with no-reflow phenomenon after PCI.

ss=""h4"">Methods

We studied 135 native de novo culprit coronary lesions in 135 patients with normal pre-PCI CK-MB levels (28 with unstable angina; 107 with stable angina) who underwent intravascular ultrasound and OCT examinations before elective stent implantation. The lesions were divided into 2 groups based on the presence or absence of EA, and OCT findings were compared. We then determined predictors of post-PCI CK-MB elevation.

ss=""h4"">Results

EA was found in 47 (34.8 % ) lesions and was associated with the presence of OCT-derived thin-capped fibroatheroma, ruptured plaques, greater lipid content, intravascular ultrasound¨Cderived large reference and plaque area, lesion eccentricity, and microcalcification. Elevated CK-MB levels were observed in 36 (26.7 % ) lesions, and significantly more frequently in lesions with EA than without. In multivariable analysis, EA (odds ratio [OR]: 3.49; 95 % confidence interval [CI]: 1.53 to 7.93; p = 0.003) and OCT-derived ruptured plaque (OR: 2.92; 95 % CI: 1.21 to 7.06; p = 0.017) were independent predictors of post-PCI CK-MB elevation.

ss=""h4"">Conclusions

Atherosclerotic plaques with EA were associated with characteristics considered to be high risk or unstable. OCT examination showed an additive predictive value to the presence of EA for post-PCI CK-MB elevation.