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Impact of Ultrasound Attenuation and Plaque Rupture as Detected by Intravascular Ultrasound on the Incidence of No-Reflow Phenomenon After Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction

Mitsuaki Endo, MD^_*, Kiyoshi Hibi, MD^_*,_*, Tomoaki Shimizu, MD, Naohiro Komura, MD^_*, Ikuyoshi Kusama, MD^_*, Fumiyuki Otsuka, MD^_*, Takayuki Mitsuhashi, MD^_*, Noriaki Iwahashi, MD^_*, Jun Okuda, MD^_*, Kengo Tsukahara, MD^_*, Masami Kosuge, MD^_*, Toshiaki Ebina, MD^_*, Satoshi Umemura, MD, Kazuo Kimura, MD^_*

^_* Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Kanagawa Prefectural Ashigara-kami Hospital, Kanagawa, Japan

^_* Reprint requests and correspondence: Dr. Kiyoshi Hibi, Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan (Email: hibikiyo{at}urahp.yokohama-cu.ac.jp).

Objectives: The aim of this study was to assess whether ultrasound attenuation and plaque rupture as detected by intravascular ultrasound (IVUS) are associated with the incidence of no-reflow phenomenon after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).

Background: No-reflow phenomenon is associated with worse long-term outcomes after STEMI. Therefore, reliable and feasible intravascular imaging techniques are needed to identify patient subgroups that would be at high risk for no-reflow phenomenon.

Methods: One hundred seventy consecutive patients with STEMI who underwent PCI within 12 h after symptom onset were enrolled. The IVUS interrogation was performed before PCI.

Results: No-reflow phenomenon occurred in 30 patients (18%), who had a higher incidence of no ST-segment resolution (50% vs. 9%; p < 0.001), a higher peak creatine kinase level (4,090 IU/l vs. 2,823 IU/l; p < 0.001), and a lower left ventricular ejection fraction in the chronic phase (51% vs. 59%; p < 0.01). Multivariate logistic regression analysis revealed that ultrasound attenuation with a longitudinal length of 5 mm, plaque rupture, and reperfusion time correlated with no-reflow phenomenon (all p < 0.05). In patients with both ultrasound attenuation 5 mm and plaque rupture, the incidence of no-reflow phenomenon was 88%, and the risk of decreased coronary reflow was higher than that predicted by either factor alone (p = 0.004 for interaction).

Conclusions: In patients with STEMI, a longer ultrasound attenuation and plaque rupture on IVUS are associated with an increased incidence of no-reflow phenomenon, suggesting that this subset of patients might be at high risk for distal embolism.

Key Words: no-reflow phenomenon • plaque rupture • ST-segment elevation myocardial infarction • ultrasound attenuation

Abbreviations and Acronyms   CI = confidence interval   CK = creatine kinase   CSA = cross-sectional area   CTFC = corrected Thrombolysis In Myocardial Infarction frame count   EEM = external elastic membrane   IVUS = intravascular ultrasound   LV = left ventricular   OR = odds ratio   PCI = percutaneous coronary intervention   P+M = plaque plus media   STEMI = ST-segment elevation myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction

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