Necrotic Core and Its Ratio to Dense Calcium Are Predictors of High-Risk Non–ST-Elevation Acute Coronary Syndrome

Missel, Eduardo; Mintz, Gary S.; Carlier, Stéphane; Sano, Koichi; Qian, Jie; Kaple, Ryan; Castellanos, Celia; Dangas, George; Mehran, Roxana; Moses, Jeffrey W.; Stone, Gregg W.; Leon, Martin B.

doi:10.1016/j.amjcard.2007.10.018

Cited by 49 publications

(37 citation statements)

References 29 publications

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“…VH-IVUS has the potential to provide detailed information about the plaque components [8,9]. Several studies have demonstrated the coronary plaque components assessed by VH-IVUS in patients with acute coronary syndrome [9,34,35]. Rodriguez-Granillo et al [9] reported that TCFA was a more prevalent finding in acute coronary syndrome than in stable angina patients.…”

Section: Discussionmentioning

confidence: 97%

“…Hong et al [34] reported that the amounts of NC were larger in patients with acute coronary syndrome compared with patients with stable angina. Missel et al [35] reported that the percentage of NC and its ratio to DC in diseased coronary segments are positively associated with a high-risk acute coronary syndrome presentation. In the present study, NC component was significantly smaller and the presence of TCFA was significantly less common at the sites of focal spasm in VA patients compared with those of culprit sites in UA patients.…”

Section: Discussionmentioning

confidence: 98%

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Plaque components at coronary sites with focal spasm in patients with variant angina: Virtual histology-intravascular ultrasound analysis

Hong

Jeong

Choi

et al. 2010

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Plaque components at coronary sites with focal spasm in patients with variant angina: Virtual histology-intravascular ultrasound analysis

Hong

Jeong

Choi

et al. 2010

International Journal of Cardiology

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“…In a study by Missel et al 34 using virtual histology, a correlation was found between a large necrotic core and reduced calcified component, with increased CK-MB release in patients with acute coronary syndrome. In this study, the volume of the necrotic core was found to be 19.2 ± 18.0 mm 3 , while the calcified component volume was 1.4 ± 13.9 mm 3 .…”

Section: Discussionmentioning

confidence: 99%

Caracterização Morfológica e Tecidual de Lesões Culpadas em Pacientes com Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST Após Uso de Fibrinolítico. Análise com Ultrassom Intracoronário e Tecnologia iMAP®

Souza

Maehara

Lima

et al. 2014

Rev. Bras. Cardiol. Invasiva

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Background: Currently, there is a great debate about the pathophysiology of acute myocardial infarction and tissue composition and morphology of lesions responsible for ischemic events. However, few studies have investigated the applicability of tissue characterization using iMAP™ technology in these patients. We evaluated patients with ST-segment elevation myocardial infarction after thrombolytic therapy with grayscale intravascular ultrasound and iMAP™ technology to describe the tissue composition of the culprit lesions. Methods: Twenty-five ST-segment elevation myocardial infarction patients with successful reperfusion had the three major epicardial coronary arteries evaluated by grayscale intravascular ultrasound and iMAP™ technology. Results: Mean age was 51 ± 11.5 years with a prevalence of males (72%). The artery most often involved was the right coronary artery (48%). Intravascular ultrasound showed that the culprit lesions were long (mean extension 31.0 ± 17.2 mm) with a high percent of plaque volume (58.5 ± 5.1%). At the point of highest obstruction (minimal luminal area), the plaque burden was 82.5 ± 7.5%. Furthermore, the mean remodeling index was 1.4 ± 1.0, indicating positive remodeling. iMAP™ analysis of the lesion and minimal luminal area showed a prevalence of fibrotic and necrotic components when compared to other components. Conclusions: In ST-segment elevation myocardial infarction patients, the culprit lesion showed a prevalence of positive arterial remodeling and the necrotic core component in the composition of the culprit plaque corroborating in vivo the main pathophysiology of acute atherosclerotic disease.

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“…Missel and colleagues [21] studied the utility of whole-vessel VH-IVUS in the culprit arteries of 225 patients presenting with a non-ST elevation myocardial infarction. They found that an elevated ratio of necrotic lipid core to dense calcium was positively associated with both creatine kinase-MB levels and ST segment depression, and thus a higher-risk ACS presentation.…”

Section: Vh-ivusmentioning

confidence: 99%

Intravascular ultrasound: Virtual histology IVUS, integrated backscatter IVUS, and palpography

Gaglia

Steinberg²,

Weissman³

2009

curr cardiovasc imaging rep

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The concept of the vulnerable plaque is the focus of much research, although our knowledge of the histology, pathobiology, natural history, and therapy of vulnerable plaque remains incomplete. The evolving intravascular ultrasound technologies of virtual histology, integrated backscatter, and palpography have yielded complementary information to traditional grayscale intravascular ultrasound, and advanced our understanding of vulnerable plaque. Although each of these techniques has enjoyed success in the academic arena, none of these techniques has been suffi ciently validated to the extent that would allow it to play a part in clinical decision-making. Their future role, both in regard to risk stratifi cation and identifi cation of vulnerable plaque, will depend upon additional rigorous studies of the natural history and treatment of vulnerable plaque.

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Necrotic Core and Its Ratio to Dense Calcium Are Predictors of High-Risk Non–ST-Elevation Acute Coronary Syndrome

Cited by 49 publications

References 29 publications

Plaque components at coronary sites with focal spasm in patients with variant angina: Virtual histology-intravascular ultrasound analysis

Plaque components at coronary sites with focal spasm in patients with variant angina: Virtual histology-intravascular ultrasound analysis

Caracterização Morfológica e Tecidual de Lesões Culpadas em Pacientes com Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST Após Uso de Fibrinolítico. Análise com Ultrassom Intracoronário e Tecnologia iMAP®

Intravascular ultrasound: Virtual histology IVUS, integrated backscatter IVUS, and palpography

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Necrotic Core and Its Ratio to Dense Calcium Are Predictors of High-Risk Non–ST-Elevation Acute Coronary Syndrome

Cited by 49 publications

References 29 publications

Plaque components at coronary sites with focal spasm in patients with variant angina: Virtual histology-intravascular ultrasound analysis

Plaque components at coronary sites with focal spasm in patients with variant angina: Virtual histology-intravascular ultrasound analysis

Caracteriza&#231;&#227;o Morfol&#243;gica e Tecidual de Les&#245;es Culpadas em Pacientes com Infarto Agudo do Mioc&#225;rdio com Supradesnivelamento do Segmento ST Ap&#243;s Uso de Fibrinol&#237;tico. An&#225;lise com Ultrassom Intracoron&#225;rio e Tecnologia iMAP&#174;

Intravascular ultrasound: Virtual histology IVUS, integrated backscatter IVUS, and palpography

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Product

Resources

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Caracterização Morfológica e Tecidual de Lesões Culpadas em Pacientes com Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST Após Uso de Fibrinolítico. Análise com Ultrassom Intracoronário e Tecnologia iMAP®