Intravascular Ultrasound Analysis of Infarct-Related and Non–Infarct-Related Arteries in Patients Who Presented With an Acute Myocardial Infarction

Abstract

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Comparison of coronary plaque rupture between stable angina and acute myocardial infarction: A three-vessel intravascular ultrasound study in 235 patients

“…Retrospective pathological studies of patients with coronary artery disease who died suddenly showed culprit lesion plaque rupture in Ϸ70% of patients. 1,2,12,13 IVUS studies have reported varying frequencies of infarct-related plaque rupture in AMI patients: 15.8% by Kotani et al, 7 37.5% by Rioufol et al, 6 37% by Fukuda et al, 8 and 55.6% by Sano et al 14 The time from symptom onset to IVUS imaging was Ͻ7 days, 7 Ͻ4 weeks, 6 Ͻ10 hours, 8 and Ͻ6 hours, 14 respectively. In the present study, plaque rupture was observed in 66% of AMI patients; the time from symptom onset to IVUS imaging was 1.4Ϯ1.9 days.…”

“…The interval from symptom onset to IVUS imaging might, in part, explain the differences among these studies. 7 There are no currently recognized IVUS features of plaque erosion. Thus, whether nonruptured culprit lesions in AMI patients represent plaque erosion, misdiagnosis, or thrombus obscuring the rupture cavity is not clear.…”

“…IVUS signs of plaque rupture suggested that a ruptured plaque contained a cavity that communicated with the lumen with an overlying residual fibrous cap fragment. 7 The diagnosis of plaque rupture required independent review and agreement by 2 of the authors (M.-K.H. and Y.-H.K.).…”

“…Identification of 2 separate plaques in the same artery (ie, infarct-related/target lesion versus non-infarct-related/target lesion) required a Ն5-mm reference segment between them; if not, they were considered to be part of one long lesion. 7 The intraplaque cavity was measured and extrapolated to the ruptured capsular area. 6 Quantitative IVUS analysis was performed by use of computerized planimetry at the infarct-related or target lesion and proximal and distal reference segments.…”

“…4 Other IVUS studies have evaluated the incidence and clinical presentation of single and multiple plaque ruptures in patients with stable angina pectoris (SAP), ACS, or AMI. [5][6][7][8] To date, the only 3-vessel IVUS study in ACS patients reported an incidence of culprit lesion plaque rupture of 37.5% (9 of 24), but 79% (19 of 24) of the patients had at least 1 secondary (nonculprit) plaque rupture. 6 These data have profound implications on strategies to identify vulnerable plaques, in particular, multiple vulnerable ruptureprone plaques, in patients at risk for an AMI.…”