Abstract 3784: Intravascular Ultrasound Predictors of No-Reflow Phenomenon after Percutaneous Saphenous Vein Graft Intervention in Patients with Acute Coronary Syndrome
We investigated the relationship between preinterventional intravascular ultrasound (IVUS) lesion characteristics and the no-reflow phenomenon after percutaneous coronary intervention (PCI) treatment of saphenous vein graft (SVG) lesions in pts with an acute coronary syndrome (ACS). Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2 after PCI. An intraluminal mass had a layered lobulated appearance, evidence of blood flow within the mass, and speckling or scintillation. Remodeling index was the ratio of the lesion site SVG cross-sectional area (CSA) to the mean of the proximal and distal references; positive remodeling was a remodeling index >1.05.
Results: Of 69 pts studied pre-PCI, no-reflow was observed in 10 pts post-PCI. There were no significant differences in graft age (12.2±5.5 vs. 8.0±3.7 yrs, p=0.117) or in the use of distal protection devices (10% vs. 14%, p=0.757), angiomax (30% vs. 20%, p=0.409), or GPIIbIIIa inhibitors (10% vs. 9%, p=0.874) comparing the two groups. In pts with no-reflow, lesion site SVG CSA, plaque CSA, and remodeling index were significantly greater; and the presence of positive remodeling, soft plaque, plaque rupture, lipid-pool like image, and an intraluminal mass were significantly more common (Table⇓). Multivariate logistic regression analysis showed that an intraluminal mass (Hazard ratio [HR]=7.272; 95% CI 1.278 – 41.385, p=0.025) and remodeling index (HR=5.362; 95% CI 1.127–14.213, p=0.030) were independent predictors of the no-reflow phenomenon after PCI of SVG lesions in pts with ACS.
Conclusions: Pre-intervention IVUS lesion characteristics -intraluminal mass and positive remodeling - predict no-reflow after PCI of SVG lesions in pts with ACS - even in pts treated using distal protection devices.