| ǥ :
|
ȣ - 530009 41 |
| Impact of Lesion Location on Acute Outcome after Percutaneous Coronary Intervention for Saphenous Vein Graft Lesions: Intravascular Ultrasound Analysis |
| 1전남대학교병원 심장센터, 2Cardiovascular Research Foundation, New York, New York, 3중앙대학교병원심장센터, 4인제대학교일산백병원, 5서울의료원, 6Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, Washington, DC |
| 홍영준1, 정명호1, Gary S. Mintz2, 김상욱3, 이성윤4, 김석연5, 안영근1, Augusto D. Pichard6, Lowell F. Satler6, Ron Waksman6, Kenneth M. Kent6, William O. Suddath6, 조정관1, 박종춘1, Neil J. Weissman6, 강정채1 |
We evaluated pre- and post-percutaneous coronary intervention (PCI) intravascular ultrasound (IVUS) images of 311 saphenous vein graft (SVG) lesions and compared IVUS findings between aorto-ostial lesions (n=64) and shaft lesions (n=247). Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2 after PCI. Plaque prolapse (PP) was defined as tissue extrusion through the stent strut post-PCI, and the volume of PP was calculated by subtracting lumen volume from stent volume.
Results: The remodeling index and plaque burden were significantly greater; and the presence of positive remodeling, hypoechoic plaque, plaque rupture, multiple plaque rupture, and an intraluminal mass were significantly more common in shaft lesions than in aorto-ostial lesions. Post-PCI no-reflow and post-PCI PP were more frequently observed, and maximum PP area and PP volume were significantly greater after PCI for shaft lesions than for aorto-ostial lesions (Table). Post-PCI creatine kinase-MB elevation more than 3 times normal was more frequently observed after PCI for shaft lesions than for aorto-ostial lesions (18% vs. 8%, p=0.043).
Conclusions: SVG shaft lesions are associated with more unstable plaque morphology and this may contribute to the worse acute PCI outcomes.
|
Variables |
Aorto-ostial lesions
(n=64) |
Shaft lesions
(n=247) |
p value |
|
Remodeling index |
0.98±0.11 |
1.03±0.16 |
0.002 |
|
Plaque burden (%) |
73.8±10.3 |
76.8±10.8 |
0.047 |
|
Positive remodeling |
14 (22%) |
99 (40%) |
0.007 |
|
Hypoechoic plaque |
23 (36%) |
116 (47%) |
0.035 |
|
Plaque rupture |
5 (8%) |
56 (23%) |
0.008 |
|
Multiple plaque rupture |
1 (2%) |
23 (9%) |
0.038 |
|
Intraluminal mass |
16 (25%) |
133 (54%) |
<0.001 |
|
Post-PCI no-reflow |
3 (5%) |
36 (15%) |
0.033 |
|
Post-PCI PP |
15 (23%) |
99 (40%) |
0.014 |
|
Maximum PP area (mm2) |
0.13±0.25 |
0.26±0.39 |
0.002 |
|
PP volume (mm3) |
0.28±0.59 |
0.59±1.09 |
0.003 |
|
|
|
