Key result
Coronary lipid volume ≥62% (HR 4.5; 95% CI 1.6-13.4) and serum PAPP-A ≥7.71 ng/mL (HR 4.32; 95% CI 1.5-12.7) independently predicted combined no-reflow during percutaneous coronary intervention.
Why the study?
Do IB-IVUS derived coronary lipid volume and serum PAPP-A levels predict the incidence of no-reflow during PCI?
Cohort (n=176)
Do IB-IVUS derived coronary lipid volume and serum PAPP-A levels predict the incidence of no-reflow during PCI?
Effect estimate: HR 4.5 (95% CI 1.6-13.4)
p-value: p=<0.01
High coronary lipid volume assessed by IB-IVUS and elevated serum PAPP-A levels independently predict the no-reflow phenomenon during PCI.
May aid no-reflow risk stratification in PCI; leaves open whether targeting lipid volume or PAPP-A improves outcomes.
AIMS: Previous studies reported that integrated backscatter intravascular ultrasound (IB-IVUS) provides high diagnostic accuracy for tissue characterization of coronary plaques and that pregnancy-associated plasma protein A (PAPP-A) could be a marker of adverse cardiac outcome in patients with cardiovascular disease. We examined whether IB-IVUS and PAPP-A levels could predict the incidence of no-reflow during percutaneous coronary intervention (PCI) METHODS AND RESULTS: About 176 consecutive patients (138 men, mean age 68 ± 11 years) who underwent PCI with IB-IVUS were prospectively enrolled. Combined no-reflow, including transient filter no-reflow by using distal protection devices, was observed in 31 patients. The percentages of coronary lipid volume (%LV) analyzed by IB-IVUS and serum PAPP-A were significantly higher in patients with combined no-reflow than normal-reflow. To predict no-reflow, a receiver operating characteristic (ROC) analysis determined cut-off values of %LV as 62% and serum PAPP-A as 7.71 ng/mL. The multivariate logistic regression analysis showed that %LV (hazard ratio 4.5, 95% confidence interval 1.6-13.4, P < 0.01) and PAPP-A (hazard ratio 4.32, 95% confidence interval 1.5-12.7, P < 0.01) were independent predictors of combined no-reflow CONCLUSIONS: %LV analyzed by IB-IVUS and serum PAPP-A levels were closely associated with the coronary no-reflow phenomenon.
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Daidoji et al. (2013) conducted a cohort in Cardiovascular disease undergoing percutaneous coronary intervention (n=176). Integrated backscatter intravascular ultrasound (%LV) and serum PAPP-A was evaluated on Combined no-reflow during percutaneous coronary intervention (HR 4.5, 95% CI 1.6-13.4, p=<0.01). Coronary lipid volume ≥62% (HR 4.5; 95% CI 1.6-13.4) and serum PAPP-A ≥7.71 ng/mL (HR 4.32; 95% CI 1.5-12.7) independently predicted combined no-reflow during percutaneous coronary intervention.
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