Key result
VH-IVUS necrotic core volume linked to ~16% higher coronary slow flow risk after STEMI PCI.
Why the study?
Coronary slow flow is an important complication of PCI associated with poor prognosis, prompting assessment of grey-scale IVUS and VH-IVUS culprit lesion characteristics in STEMI.
Does plaque burden and composition assessed by IVUS predict coronary slow flow in STEMI patients undergoing PCI?
Observational (n=295)
Does plaque burden and composition assessed by IVUS predict coronary slow flow in STEMI patients undergoing PCI?
Effect estimate: OR 1.159 (95% CI 1.030-1.305)
p-value: p=0.015
Higher necrotic core volume detected by VH-IVUS is an independent predictor of coronary slow flow in STEMI patients undergoing PCI.
May flag STEMI patients at risk for post-PCI slow flow on VH-IVUS; observational association leaves open prospective validation.
Aim Coronary slow flow (SF) is an important complication of percutaneous coronary intervention (PCI) associated with poor prognosis. The aim was to assess grey-scale intravascular ultrasound (IVUS) and virtual histology (VH-IVUS) characteristics of culprit lesion in ST-elevation myocardial infarction (STEMI).Methods A total of 295 consecutive patients with STEMI underwent coronary angiogram and IVUS. Following PCI, patients divided into two groups; SF (thrombolysis in myocardial infarction [TIMI] flow ≤ 2, n = 74) and normal flow (NF) (TIMI flow >2, n = 221). Coronary plaque burden and its composition in relation to SF were evaluated.Results On grey-scale IVUS, the plaque area (12.3 mm2 vs. 11.5 mm2, p = .01), plaque volume (110.7 mm3 vs. 99.8 mm3, p < .001), lesion external elastic membrane (EEM) cross-sectional area (14.9 mm2 vs. 14.0 mm2, p = .011) and remodelling index (1.3 vs. 1.2, p = .043) were significantly higher in SF group. On VH-IVUS, absolute fibrous volume (48.1 mm3 vs. 41.5 mm3, p ≤ .001), fibrofatty volume (23.8 mm3 vs. 18.6 mm3, p = .015), necrotic core volume (8.3 mm3 vs. 5.5 mm3, p < .001), dense calcium volume (1.2 mm3 vs. 0.6 mm3, p = .003) and thin cap fibroatheroma either single (30.1% vs. 16.1%, p < .001) or multiple (9.6% vs. 1.8%, p < .001) were higher in SF arm. In multivariable analysis, absolute necrotic core volume (odds ratio = 1.159; 95% CI 1.030–1.305, p = .015) was the only independent predictor of SF.Conclusions Higher necrotic core volume as detected by VH-IVUS may be a potential risk factor for the development of coronary SF phenomenon in patients with STEMI after PCI.
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Reddy et al. (2020) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=295). Slow flow (TIMI flow ≤ 2) vs. Normal flow (TIMI flow > 2) was evaluated on Coronary slow flow (OR 1.159, 95% CI 1.030-1.305, p=0.015). Absolute necrotic core volume detected by VH-IVUS was an independent predictor of coronary slow flow in STEMI patients after PCI (OR 1.159; 95% CI 1.030-1.305; p=0.015).
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