| 홍영준1, 정명호1, 김상욱2, 최윤하1, 마은혜1, 고점석1, 이민구1, 박근호1, 심두선1, 윤남식1, 윤현주1, 김계훈1, 박형욱1, 김주한1, 안영근1, 조정관1, 박종춘1, 강정채1 |
OBJECTIVES: We assessed the relationship between pre-stenting plaque components and post-stenting plaque prolapse (PP) and evaluated the plaque components of prolapsed plaque in patients who underwent drug-eluting stent (DES) implantation using virtual histology-intravascular ultrasound (VH-IVUS).
METHODS: This study group comprised 66 patients (34 patients had 38 PP lesions and 32 patients had 38 non-PP lesions). VH-IVUS classified the color-coded tissue into four major components: fibrotic (FT); fibro-fatty (FF); dense calcium (DC); and necrotic core (NC).
RESULTS: At the minimum lumen sites, plaque area was significantly greater (13.1±4.7 mm2 vs. 8.9±4.1 mm2, p<0.001), and absolute FT and NC areas were significantly greater (5.7±3.6 mm2 vs. 3.3±2.6 mm2, p=0.002, 2.0±1.3 mm2 vs. 1.4±1.0 mm2, p=0.015, respectively) in PP lesions compared with non-PP lesions. Plaque volume was significantly greater (235±123 mm3 vs. 185±93 mm3, p=0.050), and absolute FT and NC volumes were significantly greater (87±56 mm3 vs. 57±41 mm3, p=0.010, 32±24 mm3 vs. 19±13 mm3, p=0.004, respectively) in PP lesions compared with non-PP lesions. By multivariable analysis, absolute NC volume (OR=1.14; 95% CI 1.06-1.22, p<0.001) and absolute FT volume (OR=1.09; 95% CI 1.04-1.15, p<0.001) were independently associated with the development of PP. In intrastent prolapsed plaque, FT component was greatest, however, NC component was also large (absolute plaque area: FT 0.44±0.43 mm2, FF 0.07±0.09 mm2, DC 0.04±0.08 mm2, NC 0.10±0.22 mm2, and relative plaque area: FT 68±19%, FF 14±13%, DC 5±9%, NC 13±16%, respectively). In prolapsed plaque, %NC area correlated positively with (post-stenting minus pre-stenting values) creatine kinase-MB (r=0.535, p=0.001) and troponin-I (r=0.626, p<0.001), and %FT area correlated negatively with creatine kinase-MB (r=-0.388, p=0.026) and troponin-I (r=-0.469, p=0.006).
CONCLUSIONS: Absolute NC and FT components were associated with development of PP, and NC and FT components in prolapsed plaque were associated with post-stenting cardiac enzyme elevation after DES implantation.
|
