Coronary plaque characteristics that indicate distal embolization during percutaneous coronary intervention in patients
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ORIGINAL ARTICLE
Coronary plaque characteristics that indicate distal embolization during percutaneous coronary intervention in patients with stable angina-virtual histology intravascular ultrasound study Fumitaka Inoue • Kazuhiro Ueshima • Takatomi Fujimoto • Kihyon An • Shiro Uemura Yoshihiko Saito
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Received: 15 October 2010 / Accepted: 4 January 2013 / Published online: 5 February 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
Abstract Distal embolization (DE) is a serious complication of percutaneous coronary intervention (PCI) in patients with stable angina. The purpose of this study was to evaluate the coronary plaque characteristics that indicate DE during PCI in patients with stable angina using virtual histology intravascular ultrasound (VH-IVUS). Three hundred and sixty-four consecutive stable angina patients who underwent PCI were enrolled in this study. The patients were divided into two groups as follows: patients exhibiting DE (DE group, n = 10) and patients without DE (non-DE group, n = 354). Coronary plaque compositions were assessed by VH-IVUS. The fibro-fatty (FF) ratio (28 ± 17 vs. 11 ± 9 %, p \ 0.0001) was higher in the DE group compared with the non-DE group. The best cut-off value of FF ratio for prediction of DE was 20 %, with a sensitivity of 0.80 and a specificity of 0.81 (odds ratio; 17.1, 95 % confidence interval 3.56–82.5, p = 0.0004). Coronary plaques with a high FF ratio may be the predictor of indicating DE in patients with stable angina during PCI.
embolization is not easy, especially in patients with stable angina. In general, gray-scale intravascular ultrasound (IVUS) has been used for coronary plaque evaluation. However, gray-scale IVUS is of limited value for identifying specific plaque components [4]. Recent studies have reported that virtual histology intravascular ultrasound (VH-IVUS), which is based on spectral and amplitude analysis of radiofrequency backscatter signals, allows for reliable characterization of atherosclerotic plaque into four types: fibrous (FI), fibro-fatty (FF), dense calcium (DC), and necrotic core (NC) [5, 6]. Evaluation of coronary plaque morphology by VH-IVUS may be useful in the prediction of distal embolization. This study evaluated the coronary plaque characteristics that indicate distal embolization in patients with stable angina during PCI using VH-IVUS.
Methods Keywords Angina Coronary plaque Intravascular ultrasound Percutaneous coronary intervention (PCI)
Distal embolization is a complication of percutaneous coronary intervention (PCI) and occurs in 6–15 % of patients after undergoing PCI [1–3]. Prediction of distal F. Inoue (&) K. Ueshima T. Fujimoto K. An Department of Cardiology, Nara Prefectural Nara Hospital, 1-30-1 Hiramatsu, Nara, Nara 631-0846, Japan e-mail: [email protected] S. Uemura Y. Saito First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
Patient population and baseline characteristics This retrospective study enrolled 364 stable angina
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