Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study
Abstract 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 purpos...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-12-01
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| Series: | The Egyptian Heart Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43044-020-00121-w |
| _version_ | 1818350627959341056 |
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| author | Raghavendra Rao K Sreenivas Reddy Jeet Ram Kashyap Vadivelu Ramalingam Debabrata Dash Vikas Kadiyala Suraj Kumar Hithesh Reddy Jaspreet Kaur Ashok Kumar Naindeep Kaur Anish Gupta |
| author_facet | Raghavendra Rao K Sreenivas Reddy Jeet Ram Kashyap Vadivelu Ramalingam Debabrata Dash Vikas Kadiyala Suraj Kumar Hithesh Reddy Jaspreet Kaur Ashok Kumar Naindeep Kaur Anish Gupta |
| author_sort | Raghavendra Rao K |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-13T18:24:52Z |
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| id | doaj.art-1f2793c69d6c424abd904a4f207d6fce |
| institution | Directory Open Access Journal |
| issn | 2090-911X |
| language | English |
| last_indexed | 2024-12-13T18:24:52Z |
| publishDate | 2020-12-01 |
| publisher | SpringerOpen |
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| series | The Egyptian Heart Journal |
| spelling | doaj.art-1f2793c69d6c424abd904a4f207d6fce2022-12-21T23:35:38ZengSpringerOpenThe Egyptian Heart Journal2090-911X2020-12-0172111310.1186/s43044-020-00121-wAssociation of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology studyRaghavendra Rao K0Sreenivas Reddy1Jeet Ram Kashyap2Vadivelu Ramalingam3Debabrata Dash4Vikas Kadiyala5Suraj Kumar6Hithesh Reddy7Jaspreet Kaur8Ashok Kumar9Naindeep Kaur10Anish Gupta11Department of Cardiology, Government Medical College and HospitalDepartment of Cardiology, Government Medical College and HospitalDepartment of Cardiology, Government Medical College and HospitalDepartment of Cardiology, Government Medical College and HospitalDepartment of Cardiology, Government Medical College and HospitalDepartment of Cardiology, Government Medical College and HospitalDepartment of Cardiology, Government Medical College and HospitalDepartment of Cardiology, Government Medical College and HospitalDepartment of Cardiology, Government Medical College and HospitalDepartment of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER)Department of Cardiology, Government Medical College and HospitalDepartment of Cardiology, Government Medical College and HospitalAbstract 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.https://doi.org/10.1186/s43044-020-00121-wST-segment elevation myocardial infarctionFibrinolysisIntravascular ultrasoundVirtual histology-intravascular ultrasoundNecrotic coreTIMI flow |
| spellingShingle | Raghavendra Rao K Sreenivas Reddy Jeet Ram Kashyap Vadivelu Ramalingam Debabrata Dash Vikas Kadiyala Suraj Kumar Hithesh Reddy Jaspreet Kaur Ashok Kumar Naindeep Kaur Anish Gupta Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study The Egyptian Heart Journal ST-segment elevation myocardial infarction Fibrinolysis Intravascular ultrasound Virtual histology-intravascular ultrasound Necrotic core TIMI flow |
| title | Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study |
| title_full | Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study |
| title_fullStr | Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study |
| title_full_unstemmed | Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study |
| title_short | Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study |
| title_sort | association of culprit lesion plaque characteristics with flow restoration post fibrinolysis in st segment elevation myocardial infarction an intravascular ultrasound virtual histology study |
| topic | ST-segment elevation myocardial infarction Fibrinolysis Intravascular ultrasound Virtual histology-intravascular ultrasound Necrotic core TIMI flow |
| url | https://doi.org/10.1186/s43044-020-00121-w |
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