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AS-061 Impact of Culprit Lesion Intrathrombus Calcium in Acute ST Elevation Myocardial Infarction; A Virtual Histology Intravascular Ultrasound Analysis
Wednesday, April 27, 2011
O R A L A B S T R A C T S
lium-independent vasomotion was tested with nitrate infusion. Vascular response was estimated by quantitative coronary angiography in the 5-mm proximal and distal segments to the stent. Results: According to the grade of neointimal coverage, patients were divided into two groups; poor-coverage group (grade 0⬃1, n⫽15) and wellcoverage group (grade 2⬃3, n⫽15). In the distal segment to the stent, vasoconstriction to Ach in poor-coverage group was more intense compared to well-coverage group, but not in the proximal segment. Endothelium-independent vasodilatation was similar between the two groups.
Conclusion: Incomplete neointimal coverage at DES implanted site might be related to endothelial dysfunction at distal to stent.
AS-061 Impact of Culprit Lesion Intrathrombus Calcium in Acute ST Elevation Myocardial Infarction; A Virtual Histology Intravascular Ultrasound Analysis. Sang Wook Kim1, Wang Soo Lee1, Gary Mintz2, Akiko Maehara2, Seung Woon Rha3, Cheol Ung Choi3, Young Joon Hong4, Sung Yun Lee5, Hyun Jae Kang6, Jung Sun Kim7, Sung Jin Oh8, Wang Seong Ryu1, Neil Weissman9. 1Chung-Ang University Hospital, Seoul, Korea (Republic of); 2Cardiovascular Research Foundation, Seoul, Korea (Republic of); 3Korea University Guro Hospital, Seoul, Korea (Republic of); 4Chonnam National University Hospital, Gwangju, Korea (Republic of); 5Inje University Ilsan Paik Hospital, Ilsan, Korea (Republic of); 6Seoul National University Hospital, Seoul, Korea (Republic of); 7Yonsei University Severance Hospital, Seoul, Korea (Republic of); 8Ilsan Hospital, Ilsan, Korea (Republic of); 9 Washington Hospital Center, Washington, DC, Korea (Republic of). Background: Pathologic studies have been suggested that atherosclerotic components are often included within thrombi in infarct related arteries (IRA). Virtual Histology-Intravascular Ultrasound (VH-IVUS) misclassifies thrombus as either fibrotic or fibrofatty plaque. Conversely, the predictive accuracy of VH-IVUS detection of dense calcium (Ca) is high. Methods: We used VH-IVUS to assess the presence of Ca within intraluminal thrombi in 50 pts with acute ST elevation myocardial infarction (STEMI). VH-TCFAs were defined as necrotic core (NC) ⬎10% of plaque area, plaque burden ⬎40%, and NC in contact with the lumen for ⱖ3 image slices. Remodeling index (RI) was lesion/ reference external elastic membrane ⬎1.05. Results: Using VH-IVUS imaging, thrombi were divided into 2 groups: Ca-containing intraluminal thrombi (18 pts) and thrombi without Ca (32 pts). Calcified intraluminal thrombi were located in 9 LAD, 2 LCX, and 7 RCA. Vessel size, lesion length, plaque burden, minimal lumen area, and positive remodeling were similar in the two groups (data not shown). However, a VH-TCFA was present adjacent to 43% (14/32) of Ca-thrombi vs 22% (4/18) of thrombi without Ca (p⫽0.063). Importantly, post-PCI peak troponin was higher in the setting of Ca-thrombi (551.56⫾ 589.97 ng/ml) vs 251.18⫾273.36 ng/ml in thrombi without Ca, p⫽0.027.
24A
Conclusion: Ca is present within 40% of IRA thrombi in pts with STEMI. These Ca-containing thrombi appear to be at increased risk of distal embolization during PCI.
AS-062 Comparison of Coronary Plaque Characterization by Spectral Radiofrequency of Intravascular Ultrasound Signals (VH-IVUS and i-MAP). Atsushi Hirohata, Keizo Yamamoto, Yoshihiro Imai, Keitaro Senoh, Eiki Hirose, Yuhei Kobayashi, Hiroya Takafuji, Fumihiko Sano, Minako Ohara, Keisuke Ohkawa, Yuko Toyama, Kazumasa Nosaka, Junji Yoshida, Yuzuru Iino, Tohru Ohe. The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Background: Intravascular ultrasound (IVUS) with the spectral analysis of radiofrequency data analysis (virtual histology: VH-IVUS) has demonstrated the ability to characterize plaque into 4 distinct types: fibrous, fibro fatty, dense calcification and necrotic core. Recently, a 40 MHz mechanical rotational IVUS imaging system has shown similar ability in plaque characterization (i-MAP; fibrotic, lipidic and necrotic, calcified). However, validation of these two plaque characterization technologies by spectral radiofrequency IVUS has not been well clarified. Methods: A plaque characteristics comparison using IVUS-VH and i-MAP was performed in 845 cross-sections of 93 patients with stable angina at pre-intervention. IVUS catheter was advanced ⬎10 mm distal to the lesion, and withdrawn automatically to a point ⬎10 mm proximal to the lesion. Conventional IVUS images and radiofrequency signals were acquired and stored for off-line analysis. Based on the reference landmark, such as plaque or calcium deposition, or small branch, corresponding two cross-sections by gray scale IVUS were compared with both plaque characterizations software. Results: Average lumen, vessel and plaque area were identical between the two groups. However, in comparison of relative plaque component, larger fibrotic in i-MAP and larger dense calcium in VHIVUS were observed.
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
O R A L A B S T R A C T S
lium-independent vasomotion was tested with nitrate infusion. Vascular response was estimated by quantitative coronary angiography in the 5-mm proximal and distal segments to the stent. Results: According to the grade of neointimal coverage, patients were divided into two groups; poor-coverage group (grade 0⬃1, n⫽15) and wellcoverage group (grade 2⬃3, n⫽15). In the distal segment to the stent, vasoconstriction to Ach in poor-coverage group was more intense compared to well-coverage group, but not in the proximal segment. Endothelium-independent vasodilatation was similar between the two groups.
Conclusion: Incomplete neointimal coverage at DES implanted site might be related to endothelial dysfunction at distal to stent.
AS-061 Impact of Culprit Lesion Intrathrombus Calcium in Acute ST Elevation Myocardial Infarction; A Virtual Histology Intravascular Ultrasound Analysis. Sang Wook Kim1, Wang Soo Lee1, Gary Mintz2, Akiko Maehara2, Seung Woon Rha3, Cheol Ung Choi3, Young Joon Hong4, Sung Yun Lee5, Hyun Jae Kang6, Jung Sun Kim7, Sung Jin Oh8, Wang Seong Ryu1, Neil Weissman9. 1Chung-Ang University Hospital, Seoul, Korea (Republic of); 2Cardiovascular Research Foundation, Seoul, Korea (Republic of); 3Korea University Guro Hospital, Seoul, Korea (Republic of); 4Chonnam National University Hospital, Gwangju, Korea (Republic of); 5Inje University Ilsan Paik Hospital, Ilsan, Korea (Republic of); 6Seoul National University Hospital, Seoul, Korea (Republic of); 7Yonsei University Severance Hospital, Seoul, Korea (Republic of); 8Ilsan Hospital, Ilsan, Korea (Republic of); 9 Washington Hospital Center, Washington, DC, Korea (Republic of). Background: Pathologic studies have been suggested that atherosclerotic components are often included within thrombi in infarct related arteries (IRA). Virtual Histology-Intravascular Ultrasound (VH-IVUS) misclassifies thrombus as either fibrotic or fibrofatty plaque. Conversely, the predictive accuracy of VH-IVUS detection of dense calcium (Ca) is high. Methods: We used VH-IVUS to assess the presence of Ca within intraluminal thrombi in 50 pts with acute ST elevation myocardial infarction (STEMI). VH-TCFAs were defined as necrotic core (NC) ⬎10% of plaque area, plaque burden ⬎40%, and NC in contact with the lumen for ⱖ3 image slices. Remodeling index (RI) was lesion/ reference external elastic membrane ⬎1.05. Results: Using VH-IVUS imaging, thrombi were divided into 2 groups: Ca-containing intraluminal thrombi (18 pts) and thrombi without Ca (32 pts). Calcified intraluminal thrombi were located in 9 LAD, 2 LCX, and 7 RCA. Vessel size, lesion length, plaque burden, minimal lumen area, and positive remodeling were similar in the two groups (data not shown). However, a VH-TCFA was present adjacent to 43% (14/32) of Ca-thrombi vs 22% (4/18) of thrombi without Ca (p⫽0.063). Importantly, post-PCI peak troponin was higher in the setting of Ca-thrombi (551.56⫾ 589.97 ng/ml) vs 251.18⫾273.36 ng/ml in thrombi without Ca, p⫽0.027.
24A
Conclusion: Ca is present within 40% of IRA thrombi in pts with STEMI. These Ca-containing thrombi appear to be at increased risk of distal embolization during PCI.
AS-062 Comparison of Coronary Plaque Characterization by Spectral Radiofrequency of Intravascular Ultrasound Signals (VH-IVUS and i-MAP). Atsushi Hirohata, Keizo Yamamoto, Yoshihiro Imai, Keitaro Senoh, Eiki Hirose, Yuhei Kobayashi, Hiroya Takafuji, Fumihiko Sano, Minako Ohara, Keisuke Ohkawa, Yuko Toyama, Kazumasa Nosaka, Junji Yoshida, Yuzuru Iino, Tohru Ohe. The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Background: Intravascular ultrasound (IVUS) with the spectral analysis of radiofrequency data analysis (virtual histology: VH-IVUS) has demonstrated the ability to characterize plaque into 4 distinct types: fibrous, fibro fatty, dense calcification and necrotic core. Recently, a 40 MHz mechanical rotational IVUS imaging system has shown similar ability in plaque characterization (i-MAP; fibrotic, lipidic and necrotic, calcified). However, validation of these two plaque characterization technologies by spectral radiofrequency IVUS has not been well clarified. Methods: A plaque characteristics comparison using IVUS-VH and i-MAP was performed in 845 cross-sections of 93 patients with stable angina at pre-intervention. IVUS catheter was advanced ⬎10 mm distal to the lesion, and withdrawn automatically to a point ⬎10 mm proximal to the lesion. Conventional IVUS images and radiofrequency signals were acquired and stored for off-line analysis. Based on the reference landmark, such as plaque or calcium deposition, or small branch, corresponding two cross-sections by gray scale IVUS were compared with both plaque characterizations software. Results: Average lumen, vessel and plaque area were identical between the two groups. However, in comparison of relative plaque component, larger fibrotic in i-MAP and larger dense calcium in VHIVUS were observed.
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Oral