Evolution of nonculprit coronary atherosclerotic plaques assessed by serial virtual histology intravascular ultrasound in patients with ST-segment elevation myocardial infarction and chronic total occlusion

Abstract

ObjectiveThe pathophysiology and natural course of coronary nonculprit plaques remain unclear. We investigated whether the short-term natural course of nonculprit plaques differs between ST-segment elevation myocardial infarction (STEMI) and chronic total occlusion (CTO) patients.MethodsWe performed serial virtual histology intravascular ultrasound on nonculprit plaques in 26 STEMI and 11 CTO lesions at baseline and the 6-month follow-up.ResultsAt baseline, more lesions in the STEMI group were virtual histology intravascular ultrasound-derived thin-cap fibroatheromas (TCFA; 76.9 vs. 18.1%, P=0.002). During the follow-up period, the plaque composition changed dynamically in the STEMI group (fibrofatty: 9.8±1.9 to 17.3±2.9%, P=0.030; dense calcium: 12.7±1.8 to 8.1±1.7%, P=0.026; necrotic core: 21.1±1.8 to 15.4±2.2%, P=0.052), with a consistent plaque size. In the CTO group, the plaque composition and plaque size remained consistent without a significant change. Also, more lesions in the STEMI group remained as or progressed to TCFA, compared with the CTO group (67 vs. 11%, P=0.089). Factors associated with a persistent TCFA or with a new development of TCFA were a large necrotic core volume index and the diagnosis of STEMI, whereas new statin usage was a protective factor.ConclusionNonculprit lesions in STEMI patients were more unstable at the baseline compared with those in CTO patients. During follow-up, nonculprit lesions in STEMI and CTO patients showed a distinct pattern of change; the former were stabilized in plaque composition, whereas the latter remained consistent. The diagnosis of STEMI and a large necrotic core volume were predictors of evolution to a TCFA, and new statin usage was a protective factor.

The natural course of nonculprit coronary artery lesions; analysis by serial quantitative coronary angiography

“…Also, evaluating the entire coronary vasculature with these tools is a significant clinical burden to both the clinician and patient. [ 18 ] Therefore, we still need more feasible angiographic standards for lesion evaluation.…”

Application of virtual histological intravascular ultrasound in plaque composition assessment of saphenous vein graft diseases

“…[51] Kang et al [52] found that an elevated plaque structural stress (PSS) was more likely associated with and the presence of VH-TCFA at 12-month follow-up and the VH-derived PSS was increased in plaques responsible for MACE. Kang et al [53] showed that nonculprit lesions in ST-segment elevation myocardial infarction (STEMI) patients were more unstable at the baseline compared with those in chronic total occlusion (CTO) patients, the diagnosis of STEMI and a large NC volume were predictors of evolution to a TCFA. Several studies had investigated the impact of plaque components on no-reflow after PCI in patients with ACS.…”

Two Cases of Complications during Percutaneous Coronary Intervention for Myocardial Infarction in Patients with Concurrent Chronic Total Occlusion in an Emergency Setting

“…CTO in acute myocardial infarction (AMI) has poor outcomes despite successful primary percutaneous coronary intervention (PCI) [2,3]. Although the pathophysiology of AMI and of CTO is different, it may be challenging to identify the culprit lesion in patients with multivessel diseases, particularly in an emergency situation [4]. We describe two cases of emergency PCI using different approaches that resulted in complications in patients with AMI and concurrent CTO.…”