Impact of attenuated plaques on TIMI grade flow and clinical outcomes of coronary artery disease patients: a systematic review and meta analysis

Abstract

Background: Plaques with a large necrotic core or lipid pool and thin-cap fibroatheroma manifest as attenuated plaques on intravascular ultrasound (IVUS). Their impact on TIMI grade flow and clinical outcomes remains undefined. We performed a systematic review and meta-analysis to summarize the association between attenuated plaque and distal embolization and clinical outcomes of coronary artery disease (CAD) from pooled data of published eligible cohort studies. Methods:We searched the literature on TIMI grade flow and clinical outcomes on PubMed, Ovid, EMBASE, the Cochrane Library, CNKI and WanFang databases. Study heterogeneity and publication bias were estimated.Results: A total of 3,833 patients were enrolled in nine studies. Five studies investigated TIMI grade flow and attenuated plaques. They revealed no difference in TIMI grade flow before percutaneous coronary intervention (PCI) between the attenuated and non-attenuated plaque group (RR =1.25; 95% CI: 0.65 to 2.41; P=0.50).After balloon dilation and stent implantation, the incidence of TIMI 0~2 grade flow in the attenuated plaque group was statistically significant higher than that of the non-attenuated plaque group (RR =4.73; 95% CI: 3.03 to 7.40; P<0.001). Five other studies investigated major cardiovascular events (MACEs) and attenuated plaques and found no difference in MACE rates within three years of follow up.Conclusions: Our study presents the evidence that plaque with ultrasound signal attenuation would induce slow/no reflow phenomenon and distal embolization during PCI, but this appearance has no impact on MACE rates within three years.

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“…Tanaka et al proved that coronary microembolization is one of the main causes of slow- or no-reflow phenomena [ 16 ]. Jia et al, with the use of IVUS found that the presence of low-attenuation plaques was associated with more than four-fold increase in the risk of TIMI 0–2 [ 17 ].…”

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“…As is known, the production of superoxide anion radicals is essential for an aerobic organism. These pro-oxidative markers act as signaling molecules in various processes such as aging and apoptosis [35]. In addition, in many chronic diseases such as diabetes and ischemic vascular disease, superoxide anion radicals are important biomolecules that can alter physiological function [35].…”

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“…In contrast, NO is a potent endogenous vasodilator and also has the effect of inhibiting platelet aggregation and vascular smooth muscle cell proliferation ( Tettey et al, 2021 ). Studies have shown that impairment of endothelial function is closely related to the occurrence of CSF, and the degree of impairment of endothelial function is negatively correlated with the plasma NO level, but positively correlated with the ET-1 level ( Ma et al, 2013 ; Jia et al, 2016 ). Reactive oxygen species and oxidative stress are the main pathological mechanisms of endothelial dysfunction ( Ungvari et al, 2018 ).…”