| 홍영준¹, 김상욱² ,정명호¹ , 최윤하¹ , 이왕수² , 이광제² , 김태호² , 심두선¹ , 김주한¹ , 안영근¹ , 조정관¹ , 박종춘¹ , 김치정² , 류왕성² , 강정채¹, 박옥규¹ |
BACKGROUND: The characteristics of plaque prolapse (PP) after stent implantation are not well known.
OBJECTIVES: We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the plaque components of PP.
METHODS: The study group comprised of 77 patients who underwent VH-IVUS and stent implantation. Of these patients, 34 patients had PP lesions (n=55) and 43 patients had no PP lesions (n=92). VH-IVUS classified the color-coded tissue into four major components: fibrotic; fibro-fatty; dense calcium; and necrotic core.
RESULTS: Patients with PP had higher baseline CK-MB (6.4±7.7 U/l vs. 4.5±1.6 U/l, p=0.021), troponin-I (3.7±7.3 ng/ml vs. 0.02±0.02 ng/ml, p=0.001), and higher hs-CRP levels (1.8±2.7 mg/dl vs. 0.2±0.6 mg/dl, p<0.001). Cardiac enzyme was elevated after stenting in patients with PP compared with patients without PP [CK-MB; +9.5±38.1 U/l vs. -4.0±26.1 U/l, p=0.008, and cTnI; +5.0±16.6 ng/ml vs. -1.2±9.4 ng/ml, p=0.012, respectively]. Lesion site external elastic membrane area (19.5±6.3 mm2 vs. 15.6±5.6 mm2, p<0.001), plaque area (15.1±5.6 mm2 vs. 9.2±3.5 mm2, p<0.001), and remodeling index (1.04±0.17 vs. 0.91±0.13, p<0.001) were greater in PP lesions compared with non-PP lesions. PP area was 2.9±1.2 mm2, and fibrotic component was greatest, however, percentage of necrotic core was high in prolapsed plaque (absolute plaque area: fibrotic 0.44±0.43 mm2, fibro-fatty 0.07±0.09 mm2, dense calcium 0.04±0.08 mm2, necrotic core 0.10±0.22 mm2, and relative plaque area: fibrotic 68±19%, fibro-fatty 14±13%, dense calcium 5±9%, necrotic core 13±16%). Although there were no correlations between % fibrotic, % fibro-fatty, % dense calcium areas vs. creatine-kinase MB and troponin-I, % necrotic core area correlated with CK-MB (r=0.311, p=0.026) and troponin-I (r=0.388, p=0.005).
CONCLUSIONS: Patients with PP have higher inflammatory condition and positive remodeling with large plaque burden, and more myonecrosis after stenting compared with patients without PP. Most component of PP was fibrotic plaque, however, percentage of necrotic core was also high, and only necrotic core component of PP was associated with post-stenting cardiac enzyme elevations.
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