BACKGROUND: Several reports suggest that virtual histology intravascular ultrasound (VH-IVUS) assessment could predict microvascular damage during percutaneous coronary intervention (PCI). A novel index of microcirculatory resistance (IMR) has been developed as a reproducible and less hemodynamic-dependent index. The purpose of this study was to investigate the relationship between thin-cap fibroatheroma (TCFA) defined by VH-IVUS and a change in the IMR during PCI in patients with angina pectoris (AP). METHODS AND RESULTS: The study investigated 30 lesions from 28 AP patients. VH-IVUS imaging was performed before PCI. TCFA was defined as the presence of confluent necrotic core (>10%) without detectable overlying fibrous cap segment. Patients were divided into 2 groups according to the presence of TCFA. Using a pressure guidewire, IMR were measured before and after PCI. After successful PCI, patients were prospectively followed up clinically. TCFA was detected in 9 lesions (30%). IMR tended to improve after PCI in the non-TCFA group, but tended to worsen in the TCFA group. DeltaIMR (=IMR after PCI-IMR before PCI) was significantly higher in the TCFA group compared with the non-TCFA group (13.2+/-29.9 vs -4.4+/-16.0, P=0.04). During follow-up (mean 20 months), survival free of major adverse cardiac events was significantly less in the TCFA group than in the non-TCFA group. CONCLUSIONS: Target lesion TCFA may be related to both microvascular injury and the long-term clinical outcome after successful PCI in patients with AP.
BACKGROUND: Several reports suggest that virtual histology intravascular ultrasound (VH-IVUS) assessment could predict microvascular damage during percutaneous coronary intervention (PCI). A novel index of microcirculatory resistance (IMR) has been developed as a reproducible and less hemodynamic-dependent index. The purpose of this study was to investigate the relationship between thin-cap fibroatheroma (TCFA) defined by VH-IVUS and a change in the IMR during PCI in patients with angina pectoris (AP). METHODS AND RESULTS: The study investigated 30 lesions from 28 AP patients. VH-IVUS imaging was performed before PCI. TCFA was defined as the presence of confluent necrotic core (>10%) without detectable overlying fibrous cap segment. Patients were divided into 2 groups according to the presence of TCFA. Using a pressure guidewire, IMR were measured before and after PCI. After successful PCI, patients were prospectively followed up clinically. TCFA was detected in 9 lesions (30%). IMR tended to improve after PCI in the non-TCFA group, but tended to worsen in the TCFA group. DeltaIMR (=IMR after PCI-IMR before PCI) was significantly higher in the TCFA group compared with the non-TCFA group (13.2+/-29.9 vs -4.4+/-16.0, P=0.04). During follow-up (mean 20 months), survival free of major adverse cardiac events was significantly less in the TCFA group than in the non-TCFA group. CONCLUSIONS: Target lesion TCFA may be related to both microvascular injury and the long-term clinical outcome after successful PCI in patients with AP.
Authors: Giovanni L De Maria; Niket Patel; Mathias Wolfrum; Gregor Fahrni; George Kassimis; Italo Porto; Sam Dawkins; Robin P Choudhury; John C Forfar; Bernard D Prendergast; Keith M Channon; Rajesh K Kharbanda; Hector M Garcia-Garcia; Adrian P Banning Journal: Coron Artery Dis Date: 2017-05 Impact factor: 1.439