Skip to main content

Advertisement

SpringerLink
Log in

Impact of tissue protrusion after coronary stenting in patients with ST-segment elevation myocardial infarction

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Clinical impact of tissue protrusion (TP) after coronary stenting is still controversial, especially in patients with ST-segment elevation myocardial infarction (STEMI). A total of 104 STEMI patients without previous MI who underwent primary percutaneous coronary intervention (PCI) under intravascular ultrasound (IVUS)-guidance were included. Post-stenting grayscale IVUS analysis was performed, and the patients were classified according to the presence or absence of post-stenting TP on IVUS. Coronary angiography and single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) with 99mTc tetrofosmin were analyzed. Major adverse cardiac events were defined as cardiovascular death, myocardial infarction, heart failure hospitalization, and target vessel revascularization. TP on IVUS was detected in 62 patients (60%). Post-PCI coronary flow was more impaired, and peak creatine kinase-myoglobin binding level was higher in patients with TP compared to those without. SPECT MPI was performed in 77 out of 104 patients (74%) at 35.4 ± 7.7 days after primary PCI. In patients with TP, left ventricular ejection fraction was significantly reduced (47.5 ± 12.0% vs. 57.6 ± 11.2%, p < 0.001), and infarct size was larger [17% (8–25) vs. 4% (0–14), p = 0.002] on SPECT MPI. During a median follow-up of 14 months after primary PCI, Kaplan–Meier analysis demonstrated a significantly higher incidence of major adverse cardiac events in patients with TP compared to those without. TP on IVUS after coronary stenting was associated with poor outcomes in patients with STEMI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Berti V, Sciagrà R, Acampa W et al (2011) Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling after acute myocardial infarction. Eur J Nucl Med Mol Imaging 38:1124–1131

    Article  PubMed  Google Scholar 

  2. Puymirat E, Simon T, Cayla G et al (2017) Acute myocardial infarction: changes in patient characteristics, management, and 6-month outcomes over a period of 20 years in the FAST-MI program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015. Circulation 136:1908–1919

    Article  PubMed  Google Scholar 

  3. Hong YJ, Jeong MH, Ahn Y et al (2008) Plaque prolapse after stent implantation in patients with acute myocardial infarction: an intravascular ultrasound analysis. JACC Cardiovasc Imaging 1:489–497

    Article  PubMed  Google Scholar 

  4. Qiu F, Mintz GS, Witzenbichler B et al (2016) Prevalence and clinical impact of tissue protrusion after stent implantation: an ADAPT-DES intravascular ultrasound substudy. JACC Cardiovasc Interv 9:1499–1507

    Article  PubMed  Google Scholar 

  5. Maehara A, Mintz GS, Lansky AJ et al (2009) Volumetric intravascular ultrasound analysis of Paclitaxel-eluting and bare metal stents in acute myocardial infarction: the harmonizing outcomes with revascularization and stents in acute myocardial infarction intravascular ultrasound substudy. Circulation 120:1875–1882

    Article  PubMed  Google Scholar 

  6. Hong YJ, Jeong MH, Choi YH et al (2010) Differences in intravascular ultrasound findings in culprit lesions in infarct-related arteries between ST segment elevation myocardial infarction and non-ST segment elevation myocardial infarction. J Cardiol 56:15–22

    Article  PubMed  Google Scholar 

  7. Futamatsu H, Sabaté M, Angiolillo DJ et al (2006) Characterization of plaque prolapse after drug-eluting stent implantation in diabetic patients: a three-dimensional volumetric intravascular ultrasound outcome study. J Am Coll Cardiol 48:1139–1145

    Article  PubMed  Google Scholar 

  8. Cheneau E, Leborgne L, Mintz GS et al (2003) Predictors of subacute stent thrombosis: results of a systematic intravascular ultrasound study. Circulation 108:43–47

    Article  PubMed  Google Scholar 

  9. Farb A, Burke AP, Kolodgie FD, Virmani R (2003) Pathological mechanisms of fatal late coronary stent thrombosis in humans. Circulation 108:1701–1706

    Article  PubMed  Google Scholar 

  10. Dong L, Mintz GS, Witzenbichler B et al (2015) Comparison of plaque characteristics in narrowings with ST-elevation myocardial infarction (STEMI), non-STEMI/unstable angina pectoris and stable coronary artery disease (from the ADAPT-DES IVUS Substudy). Am J Cardiol 115:860–866

    Article  PubMed  Google Scholar 

  11. Steg PG, James SK, Atar D et al (2012) ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33:2569–2619

    Article  CAS  PubMed  Google Scholar 

  12. Scanlon PJ, Faxon DP, Audet AM et al (1999) ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 33:1756–1824

    Article  CAS  PubMed  Google Scholar 

  13. TIMI IIIB Investigators (1994) Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave myocardial infarction: results of the TIMI IIIB trial: thrombolysis in myocardial ischemia. Circulation 89:1545–1556

    Article  Google Scholar 

  14. Mintz GS, Nissen SE, Anderson WD et al (2001) American College of Cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (IVUS): a report of the American College of Cardiology Task Force on clinical expert consensus documents. J Am Coll Cardiol 37:1478–1492

    Article  CAS  PubMed  Google Scholar 

  15. Amano T, Matsubara T, Uetani T et al (2008) Abnormal glucose regulation is associated with lipid-rich coronary plaque: relationship to insulin resistance. JACC Cardiovasc Imaging 1:39–45

    Article  PubMed  Google Scholar 

  16. Germano G, Kavanagh PB, Waechter P et al (2000) A new algorithm for the quantitation of myocardial perfusion SPECT. I: technical principles and reproducibility. J Nucl Med 41:712–719

    CAS  PubMed  Google Scholar 

  17. Germano G, Kiat H, Kavanagh PB et al (1995) Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 36:2138–2147

    CAS  PubMed  Google Scholar 

  18. Hong YJ, Jeong MH, Choi YH et al (2013) Impact of tissue prolapse after stent implantation on short- and long-term clinical outcomes in patients with acute myocardial infarction: an intravascular ultrasound analysis. Int J Cardiol 166:646–651

    Article  PubMed  Google Scholar 

  19. Lansky AJ, Ng VG, Maehara A et al (2012) Gender and the extent of coronary atherosclerosis, plaque composition, and clinical outcomes in acute coronary syndromes. JACC Cardiovasc Imaging 5:S62–S72

    Article  PubMed  Google Scholar 

  20. Choi SY, Witzenbichler B, Maehara A et al (2011) Intravascular ultrasound findings of early stent thrombosis after primary percutaneous intervention in acute myocardial infarction: a harmonizing outcomes with revascularization and stents in acute myocardial infarction (HORIZONS-AMI) substudy. Circ Cardiovasc Interv 4:239–247

    Article  PubMed  Google Scholar 

  21. Katayama T, Kubo N, Takagi Y et al (2006) Relation of atherothrombosis burden and volume detected by intravascular ultrasound to angiographic no-reflow phenomenon during stent implantation in patients with acute myocardial infarction. Am J Cardiol 97:301–304

    Article  PubMed  Google Scholar 

  22. Hong YJ, Jeong MH, Choi YH et al (2011) Impact of plaque components on no-reflow phenomenon after stent deployment in patients with acute coronary syndrome: a virtual histology-intravascular ultrasound analysis. Eur Heart J 32:2059–2066

    Article  PubMed  Google Scholar 

  23. Morishima I, Sone T, Okumura K et al (2000) Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol 36:1202–1209

    Article  CAS  Google Scholar 

  24. Nakano M, Yahagi K, Otsuka F et al (2014) Causes of early stent thrombosis in patients presenting with acute coronary syndrome: an ex vivo human autopsy study. J Am Coll Cardiol 63:2510–2520

    Article  PubMed  Google Scholar 

  25. Farb A, Weber DK, Kolodgie FD, Burke AP, Virmani R (2002) Morphological predictors of restenosis after coronary stenting in humans. Circulation 105:2974–2980

    Article  PubMed  Google Scholar 

  26. Soeda T, Uemura S, Park SJ et al (2015) Incidence and clinical significance of poststent optical coherence tomography findings: one-year follow-up study from a multicenter registry. Circulation 132:1020–1029

    Article  PubMed  Google Scholar 

  27. Lee CH, Low A, Tai BC et al (2007) Pretreatment with intracoronary adenosine reduces the incidence of myonecrosis after non-urgent percutaneous coronary intervention: a prospective randomized study. Eur Heart J 28:19–25

    Article  CAS  PubMed  Google Scholar 

  28. Murakami M, Iwasaki K, Kusachi S et al (2006) Nicorandil reduces the incidence of minor cardiac marker elevation after coronary stenting. Int J Cardiol 107:48–53

    Article  PubMed  Google Scholar 

  29. Ibanez B, James S, Agewall S et al (2018) 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 39:119–177

    Article  Google Scholar 

  30. Lutter C, Mori H, Yahagi K et al (2016) Histopathological differential diagnosis of optical coherence tomographic image interpretation after stenting. JACC Cardiovasc Interv 9:2511–2523

    Article  PubMed  Google Scholar 

  31. Tasal A, Bacaksiz A, Vatankulu MA et al (2013) Is postdilatation with a noncompliant balloon necessary after coronary stent deployment during primary angioplasty? J Interv Cardiol 26:325–331

    Article  PubMed  Google Scholar 

  32. Maekawa Y, Asakura Y, Anzai T et al (2005) Relation of stent overexpansion to the angiographic no-reflow phenomenon in intravascular ultrasound-guided stent implantation for acute myocardial infarction. Heart Vessels 1:13–18

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Chiba Emergency Medical Center, 1-32-3 Isobe, Mihama-ku, Chiba, Chiba, 261-0012, Japan

    Yoshiyuki Okuya, Yoshiaki Sakai & Iwao Ishibashi

  2. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan

    Yuichi Saito & Yoshio Kobayashi

Authors
  1. Yoshiyuki Okuya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuichi Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshiaki Sakai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Iwao Ishibashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshio Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshiyuki Okuya.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okuya, Y., Saito, Y., Sakai, Y. et al. Impact of tissue protrusion after coronary stenting in patients with ST-segment elevation myocardial infarction. Int J Cardiovasc Imaging 35, 401–407 (2019). https://doi.org/10.1007/s10554-018-1465-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-018-1465-3

Keywords

Search

Navigation