Abstract 17866: Assessment of Echo-Attenuated Plaque by Optical Coherence Tomography and its Impact on Post-procedural CK-MB Elevation in Elective Stent Implantation
Background: Recent intravascular ultrasound (IVUS) studies have described atherosclerotic plaques with echo attenuation (EA) without associated bright echoes that are correlated with no-reflow phenomenon after percutaneous coronary intervention (PCI). We investigated echo-attenuated plaques by optical coherence tomography (OCT) and evaluated their impact on post-PCI creatine kinase-MB (CK-MB) elevation in patients with elective stent implantation.
Methods and Results: We studied 135 native de novo culprit coronary lesions in 135 patients with normal pre-PCI CK-MB levels (28: unstable angina; 107: stable angina) who underwent IVUS and OCT examinations before elective stent implantation. The lesions were divided into two groups based on the presence or absence of EA and OCT findings were compared. We then determined predictors of post-PCI CK-MB elevation. Further, angioscopic examination was performed in 12 lesions with EA. EA was found in 47 (34.8%) lesions, and was associated with higher frequencies of OCT-derived thin-capped fibroatheroma (TCFA; EA: 51.1% vs. non-EA: 21.6%, P < 0.01), thinnest cap thickness (EA: 60μm [interquartile range: IQR, 50–100μm] vs. non-EA: 85μm [IQR, 60–120μm], P < 0.01), and greater lipid content (lipid quadrants 1 (EA 6.4% vs. non-EA 21.6%), 2 (EA 23.4% vs. non-EA 15.9%), 3 (EA 34.0% vs. non-EA 22.7%), and 4 (EA 31.9% vs. non-EA 17.0%), P < 0.01). Elevated CK-MB levels were observed in 36 (26.7%) lesions and significantly more frequently in lesions with EA than without (EA: 44.7% vs. non-EA: 17.0%, P < 0.01). In multivariate analysis, EA (OR, 3.49; 95% CI, 1.53–7.93, P = 0.003) and OCT-derived ruptured plaque (OR, 2.92; 95% CI, 1.21–7.06, P = 0.017) were independent predictors of post-PCI CK-MB elevation. Angioscopy identified yellow plaques in 8 EA lesions and white plaques in 4 EA lesions with or without thrombus.
Conclusions: Atherosclerotic plaques with EA were associated with characteristics considered to be high-risk. OCT examination showed a significant additive predictive value to the presence of EA for post-PCI CK-MB elevation.
- © 2010 by American Heart Association, Inc.