Impact of plaque burden and composition on coronary slow flow in ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: intravascular ultrasound and virtual histology analysis

Reddy, Srinivas Gosla; K, Raghavendra Rao; Kashyap, Jeet Ram; Kadiyala, Vikas; Reddy, Hithesh; Malhotra, Samir; Kumar, Sharma Vijay; Soni, Hariom; Kaur, Naindeep; Kaur, Jaspreet; Vadivelu, Ramalingam

doi:10.1080/00015385.2020.1767842

Cited by 6 publications

(6 citation statements)

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“…On virtual histology, the necrotic core comprises cholesterol crystals, lipid-laden foam cells, microcalcifications, and microhemorrhages. The substantial increase of these elements noted in STEMI with plaque rupture when embolized to distal coronary microcirculation contributes to slow flow [13,14,45]. Giannopoulos et al showed that the relative necrotic core percentage by VH-IVUS in culprit lesions with STEMI are linked to coronary flow restoration following thrombolysis and was significantly higher in patients with TIMI flow grades 1-2 [46].…”

Section: Discussionmentioning

confidence: 99%

Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study

Reddy

Kashyap

et al. 2020

Egypt Heart J

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Background Not every patient achieves normal coronary flow following fibrinolysis in STEMI (ST-segment elevation myocardial infarction). The culprit lesion plaque characteristics play a prominent role in the coronary flow before and during percutaneous coronary intervention. The main purpose was to determine the culprit lesion plaque features by virtual histology-intravascular ultrasound (VH-IVUS) in patients with STEMI following fibrinolysis in relation to baseline coronary angiogram TIMI (thrombolysis in myocardial infarction) flow. Pre-intervention IVUS was undertaken in 61 patients with STEMI after successful fibrinolysis. After the coronary angiogram, they were separated into the TIMI1–2 flow group (n = 31) and TIMI 3 flow group (n = 30). Culprit lesion plaque composition was evaluated by VH-IVUS. Results On gray-scale IVUS, the lesion external elastic membrane cross-sectional area (EEM CSA) was significantly higher in the TIMI 1–2 groups as compared to the TIMI 3 group (15.71 ± 3.73 mm2 vs 13.91 ± 2.94 mm2, p = 0.041) with no significant difference in plaque burden (82.42% vs. 81.65%, p = 0.306) and plaque volume (108.3 mm3 vs. 94.3 mm3, p = 0.194). On VH-IVUS, at the minimal luminal area site (MLS), the fibrous area (5.83 mm2 vs. 4.37 mm2, p = 0.024), necrotic core (NC) area (0.95 mm2 vs. 0.59 mm2, p < 0.001), and NC percentage (11% vs. 7.1%, p = 0.024) were higher in the TIMI 1–2 groups in contrast to the TIMI 3 group. The absolute necrotic core (NC) volume (8.3 mm3 vs. 3.65 mm3, p < 0.001) and NC percentage (9.3% vs. 6.0%, p = 0.007) were significantly higher in the TIMI 1–2 groups as compared to the TIMI 3 group. Absolute dense calcium (DC) volume was higher in TIMI 1–2 groups with a trend towards significance (1.0 mm3 vs.0.75 mm3, p = 0.051). In multivariate analysis, absolute NC volume was the only independent predictor of TIMI 1–2 flow (odds ratio = 1.561; 95% CI 1.202–2.026, p = 0.001). Receiver operating characteristic curves showed absolute NC volume has best diagnostic accuracy (AUC = 0.816, p < 0.001) to predict TIMI 1–2 flow with an optimal cutoff value of 4.5 mm3 with sensitivity and specificity of 79% and 61%, respectively. Conclusions This study exemplifies that the necrotic core component of the culprit lesion plaque in STEMI is associated with the coronary flow after fibrinolysis. The absolute necrotic core volume is a key determinant of flow restoration post-fibrinolysis and aids in prognostication of less than TIMI 3 flow.

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Section: Discussionmentioning

confidence: 99%

Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study

Reddy

Kashyap

et al. 2020

Egypt Heart J

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“…Shah et al [ 20 ] found that predictors built on the basis of history and angiographical features could predict the occurrence of slow flow/no-reflow phenomenon after primary PCI. Reddy et al [ 21 ] found that higher necrotic core volume detected by intravascular ultrasound and virtual histology might be a potential risk factor for CSF phenomenon after PCI in patients with ST-elevation myocardial infarction. Carrick et al [ 22 ] found that deferred stenting might reduce the slow flow/no-reflow phenomenon in primary PCI and increase myocardial salvage.…”

Section: Discussionmentioning

confidence: 99%

Coronary slow flow research: a bibliometric analysis

Tong,

Bei,

Zhang

et al. 2023

Eur J Med Res

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Background Studies on coronary slow flow are receiving increasing attention, but objective evaluations are still lacking. The purpose of this study was to visualize the current status and research hotspots of coronary slow flow through bibliometric analysis. Methods All relevant publications on coronary slow flow from 2003 to 2022 were extracted from the Web of Science Core Collection database and analyzed by VOSviewer and CiteSpace visualization software. Year of publication, journal, country/region, institution, and first author of each paper, as well as research hotspots were identified. Results A total of 913 publications were retrieved. The journal with the most publications was Coronary Artery Disease. The country/region with the most publications was Turkey, followed by China and the United States. The institution with the largest publication volume was Turkey Specialized Higher Education Research Hospital. The author with the largest publication volume was Chun-Yan Ma from China. Keyword analysis indicated that “treatment and prognosis”, “pathogenesis and risk factors” and “diagnosis” were the clustering centers of coronary slow flow, and the research hotspots gradually changed with time, from pathogenesis to treatment and prognosis. Conclusion Future research will focus on the search for effective and non-invasive detection indicators and treatments of coronary slow flow. Collaboration needs to be enhanced between different institutions or countries/regions, which would improve clinical outcomes for patients with coronary slow flow.

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“…RI was defined as the external elastic membrane (EEM) at the minimal lumen area (MLA) divided by the average of the proximal and distal reference external elastic membrane areas at the cross sectional areas (CSA). 10,[14][15][16][17][18][19] Positive RI cut points vary in studies between 1.00 and1.05, while a negative RI is generally considered <0.88, and an intermediate RI between 0.88 and 1.00. 14,17 dIagnostIc mEthods Invasive coronary angiography (ICA) has been the only available method for to imaging assessment of coronary arteries, and it is still the gold standard.…”

Section: Definitions Of Remodelingmentioning

confidence: 99%

“…39 Several studies examined the characteristics of the culprit lesion in ST-elevation myocardial infarction and the role of plaque volume in the pathogenesis of slow flow, and found that the presence of IVUS parameters (lesion of the external elastic membrane at the cross-section area, plaque area, plaque volume, and remodeling index) was significantly higher in the slow flow group compared to the normal flow group. 15,[40][41][42] IVUS can also be used for evaluation before and after stent placement, and to identify the presence of in-stent restenosis. A recent study demonstrated the importance of assessing the severity of remodeling using IVUS, indicating that an IVUS-guided strategy is more effective for stent implantation than angiography alone.…”

Section: Intravascular Ultrasoundmentioning

confidence: 99%

Positive Remodeling – a Major Feature of Vulnerability in Patients with Non-Obstructive Coronary Artery Disease

Szabó¹,

Opincariu²,

Mester³

et al. 2021

Journal of Interdisciplinary Medicine

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The most common cause of acute coronary syndrome is thrombosis of an atheromatous plaque. Positive remodeling is the compensatory dilatation of the plaque-containing section of the vessel wall. Plaques are most commonly characterized as vulnerable when possessing some of the following features: fibrous cap thickness <65 µm, large necrotic lipid core, high degrees of inflammatory infiltrates, positive remodeling, intraplaque hemorrhage, or neoangio-genesis. The presence of these plaque features is associated with high cardiovascular risk. In the initial stage of vasculopathy, due to positive remodeling, lumen reduction is not typical; it only develops in the advanced phase of the disease, due to which, based on a lumenogram, the vascular system may appear intact. Therefore, coronary angiography can easily miss the diagnosis or underestimate its extent, since it does not inform us of the composition of the arterial wall, because the contrast agent is just filling the vessel lumen. Coronary CT angiography may fill this diagnostic gap, since changes of the vessel wall can directly be visualized. To increase diagnostic accuracy, invasive coronary angiography can be completed by intravascular ultrasound and optical coherence tomography.

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Impact of plaque burden and composition on coronary slow flow in ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: intravascular ultrasound and virtual histology analysis

Cited by 6 publications

References 50 publications

Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study

Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study

Coronary slow flow research: a bibliometric analysis

Positive Remodeling – a Major Feature of Vulnerability in Patients with Non-Obstructive Coronary Artery Disease

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