Abstract 16774: Impact of Thin-Cap Fibroatheroma as Strong Predictor for No-Reflow Phenomenon After Stent Implantation in Acute as Well as Stable Coronary Syndrome: Results From Study With Optical Coherence Tomography
Objective: The aim of this study was to determine the optical coherence tomographic (OCT) predictor for angiographic no-reflow phenomenon after coronary stent implantation in terms of the appropriate indication for distal protection device in acute as well as stable coronary syndrome.
Background: The incidence of distal embolization during PCI may result in impaired myocardial perfusion and worsen the clinical prognosis. However, few data exists regarding the predictor of this incidence using OCT modality.
Methods: This study comprised 60 consecutive patients undergoing OCT-guided stenting for stable (n = 27, male=18, mean age =68) and acute (n = 33, male=27, mean age =67) coronary syndromes with de novo lesion. Angiographic no-reflow phenomenon, including so-called filter no-reflow, was defined as post-stenting TIMI 0, 1, or 2 flow in the absence of a mechanical obstruction on angiograms. We examined the prevalence of thin-cap fibroatheroma (TCFA), thrombus, lipid plaque, calcification and rupture using OCT modality. TCFA was defined as a plaque presenting lipid content for more than 90°, and with thinnest part of the fibrous cap measuring less than 70 μm.
Results: On the basis of post-stenting TIMI flow, patients could be divided into two groups: no-reflow group (n = 8) and reflow group (n = 52). Diameter stenosis of no-reflow group was significantly larger compared with that of reflow group (88±15 vs. 72±15 %, p = 0.008). Minimal luminal diameter of no-reflow group was significantly smaller compared with that of reflow group (0.4±0.5 vs. 0.7±0.5 mm, p = 0.04). The existence of TCFA (75 vs. 27 %, p = 0.01) and thrombus (100 vs. 48 %, p = 0.006) were more frequently observed in the no-reflow group compared with the reflow group. A multivariable logistic regression model revealed that TCFA alone was an independent predictor of no-reflow phenomenon (odds ratio 7.41; CI 1.11–49.4; p = 0.03).
Conclusion: These results demonstrate that TCFA detected by OCT could be a strong predictor for no-reflow phenomenon during stent implantation in acute as well as stable coronary syndrome. We suggest the use of distal protection device in such cases regardless of stability of disease.
- © 2010 by American Heart Association, Inc.