Abstract 2825: Incidence, Predictors, and Outcome of Plaque Prolapse after Stent Implantation in Patients with Acute Myocardial Infarction: An Intravascular Ultrasound Analysis
Background: Plaque prolapse (PP) is not a rare phenomenon and has been detected frequently by intravascular ultrasound (IVUS). However, data on the incidence, predictors, and outcome of PP in patients with acute myocardial infarction (AMI) are lacking.
Objectives and Methods: We used IVUS to assess the incidence, predictors, and outcome of PP after stent implantation (138 Sirolimus-eluting stent; 49 Paclitaxel-eluting stent; 123 Bare-metal stents) in 310 AMI patients (125 STEMI and 185 NSTEMI). PP was defined as tissue extrusion through the stent strut post-procedure, and the volume of PP was calculated by subtracting lumen volume from stent volume.
Results: Immediately after stenting, PP was detected in 27.4% (maximum PP area; 0.7±0.5 mm2, PP volume; 2.3±1.7 mm3) without difference according to stent types. In patients with PP, stent length was longer (30.9±13.4 vs. 21.5±8.5 mm, p<0.001); more stents were deployed (1.5±0.6 vs. 1.1±0.3, p<0.001); and inflation pressure was significantly higher (15.3±2.9 vs. 14.1±2.6 mmHg, p=0.001). Lesion site plaque cross-sectional area (CSA), plaque burden, and remodeling index were greater; calcium arc was smaller; the presence of positive remodeling, hypoechoic plaque, plaque rupture, and thrombus were significantly more common in patients with PP. Cardiac enzyme was more significantly elevated after stenting in patients with PP compared with patients without PP (Table⇓). Multivariate logistic regression analysis showed that stent length (HR=2.39; 95% CI 1.17–3.89, p=0.003), plaque rupture (HR=1.96; 95% CI 1.14 –3.37, p=0.015), and positive remodeling (HR=1.72; 95% CI 1.01–2.92, p=0.044) were independently associated with the development of PP.
Conclusions: Pre-intervention IVUS lesion characteristics - plaque rupture and positive remodeling - and longer stent length predict PP, and PP is associated with myonecrosis after stenting for infarct-related artery in patients with AMI.