Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Ischemic Heart Disease
Target Lesion Thin-Cap Fibroatheroma Defined by Virtual Histology Intravascular Ultrasound Affects Microvascular Injury During Percutaneous Coronary Intervention in Patients With Angina Pectoris
Ryotaro YamadaHiroyuki OkuraTeruyoshi KumeYoji NeishiTakahiro KawamotoYoshinori MiyamotoKoichiro ImaiKen SaitoTetsuo TsuchiyaAkihiro HayashidaKiyoshi Yoshida
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2010 Volume 74 Issue 8 Pages 1658-1662

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Abstract

Background: Several reports suggest that virtual histology intravascular ultrasound (VH-IVUS) assessment could predict microvascular damage during percutaneous coronary intervention (PCI). A novel index of microcirculatory resistance (IMR) has been developed as a reproducible and less hemodynamic-dependent index. The purpose of this study was to investigate the relationship between thin-cap fibroatheroma (TCFA) defined by VH-IVUS and a change in the IMR during PCI in patients with angina pectoris (AP). Methods and Results: The study investigated 30 lesions from 28 AP patients. VH-IVUS imaging was performed before PCI. TCFA was defined as the presence of confluent necrotic core (>10%) without detectable overlying fibrous cap segment. Patients were divided into 2 groups according to the presence of TCFA. Using a pressure guidewire, IMR were measured before and after PCI. After successful PCI, patients were prospectively followed up clinically. TCFA was detected in 9 lesions (30%). IMR tended to improve after PCI in the non-TCFA group, but tended to worsen in the TCFA group. ΔIMR (=IMR after PCI-IMR before PCI) was significantly higher in the TCFA group compared with the non-TCFA group (13.2±29.9 vs -4.4±16.0, P=0.04). During follow-up (mean 20 months), survival free of major adverse cardiac events was significantly less in the TCFA group than in the non-TCFA group. Conclusions: Target lesion TCFA may be related to both microvascular injury and the long-term clinical outcome after successful PCI in patients with AP.  (Circ J 2010; 74: 1658 - 1662)

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© 2010 THE JAPANESE CIRCULATION SOCIETY
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