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Rao K R, Reddy S, Kashyap JR, Ramalingam V, Dash D, Kadiyala V, Kumar S, Reddy H, Kaur J, Kumar A, Kaur N, Gupta A. Association of culprit lesion plaque characteristics with flow restoration post-fibrinolysis in ST-segment elevation myocardial infarction: an intravascular ultrasound-virtual histology study. Egypt Heart J 2020; 72:86. [PMID: 33296051 PMCID: PMC7726087 DOI: 10.1186/s43044-020-00121-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/27/2020] [Indexed: 12/19/2022] Open
Abstract
Background Not every patient achieves normal coronary flow following fibrinolysis in STEMI (ST-segment elevation myocardial infarction). The culprit lesion plaque characteristics play a prominent role in the coronary flow before and during percutaneous coronary intervention. The main purpose was to determine the culprit lesion plaque features by virtual histology-intravascular ultrasound (VH-IVUS) in patients with STEMI following fibrinolysis in relation to baseline coronary angiogram TIMI (thrombolysis in myocardial infarction) flow. Pre-intervention IVUS was undertaken in 61 patients with STEMI after successful fibrinolysis. After the coronary angiogram, they were separated into the TIMI1–2 flow group (n = 31) and TIMI 3 flow group (n = 30). Culprit lesion plaque composition was evaluated by VH-IVUS. Results On gray-scale IVUS, the lesion external elastic membrane cross-sectional area (EEM CSA) was significantly higher in the TIMI 1–2 groups as compared to the TIMI 3 group (15.71 ± 3.73 mm2 vs 13.91 ± 2.94 mm2, p = 0.041) with no significant difference in plaque burden (82.42% vs. 81.65%, p = 0.306) and plaque volume (108.3 mm3 vs. 94.3 mm3, p = 0.194). On VH-IVUS, at the minimal luminal area site (MLS), the fibrous area (5.83 mm2 vs. 4.37 mm2, p = 0.024), necrotic core (NC) area (0.95 mm2 vs. 0.59 mm2, p < 0.001), and NC percentage (11% vs. 7.1%, p = 0.024) were higher in the TIMI 1–2 groups in contrast to the TIMI 3 group. The absolute necrotic core (NC) volume (8.3 mm3 vs. 3.65 mm3, p < 0.001) and NC percentage (9.3% vs. 6.0%, p = 0.007) were significantly higher in the TIMI 1–2 groups as compared to the TIMI 3 group. Absolute dense calcium (DC) volume was higher in TIMI 1–2 groups with a trend towards significance (1.0 mm3 vs.0.75 mm3, p = 0.051). In multivariate analysis, absolute NC volume was the only independent predictor of TIMI 1–2 flow (odds ratio = 1.561; 95% CI 1.202–2.026, p = 0.001). Receiver operating characteristic curves showed absolute NC volume has best diagnostic accuracy (AUC = 0.816, p < 0.001) to predict TIMI 1–2 flow with an optimal cutoff value of 4.5 mm3 with sensitivity and specificity of 79% and 61%, respectively. Conclusions This study exemplifies that the necrotic core component of the culprit lesion plaque in STEMI is associated with the coronary flow after fibrinolysis. The absolute necrotic core volume is a key determinant of flow restoration post-fibrinolysis and aids in prognostication of less than TIMI 3 flow.
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Affiliation(s)
- Raghavendra Rao K
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Sreenivas Reddy
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India.
| | - Jeet Ram Kashyap
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Vadivelu Ramalingam
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Debabrata Dash
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Vikas Kadiyala
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Suraj Kumar
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Hithesh Reddy
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Jaspreet Kaur
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Ashok Kumar
- Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Naindeep Kaur
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Anish Gupta
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
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Invasive coronary angiography findings across the CAD-RADS classification spectrum. Int J Cardiovasc Imaging 2019; 35:1955-1961. [PMID: 31227952 DOI: 10.1007/s10554-019-01654-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
The recently introduced coronary artery disease reporting and data system (CAD-RADS) evaluated by computed tomography and based on stenosis severity, might not adequately reflect the complexity of CAD. We explored the relationship between CAD-RADS and the spatial distribution, burden, and complexity of lesions by invasive coronary angiography (ICA). Stable patients who underwent coronary computed tomography angiography (CCTA) and ICA comprised the study population. Patients were classified according to the CAD-RADS: 0, No plaque; 1, 1-24% stenosis; 2, 25-49%; 3, 50-69%; 4A, 70-99%; 4B, left main stenosis or 3-vessel obstructive disease; and 5, total occlusion. Based on ICA findings, we calculated the SYNTAX score and the CAD extension index. Ninety-one patients were included, with a mean age of 61.4 ± 10.5 years (74% male). We found significant relationships between CAD-RADS and both the SYNTAX score (p < 0.0001) and the CAD extension index (p < 0.0001), although the complexity of coronary anatomy differed among patients with CAD-RADS ≥ 4A. Among patients with CAD-RADS < 4, the mean segment involvement score (SIS) was 8.4 ± 4.0, 52% of them with a SIS > 5. Of the 30 patients with CAD-RADS 5, 9 (30%) affected distal segments or secondary branches, and 9 (30%) had concomitant severe non-extensive disease at ICA. Regarding the spatial distribution of the non-occluded most severe lesions, 27 (44%) comprised distal segments or secondary branches. In the present study including a high-risk population, we identified diverse coronary anatomy complexity scenarios and relevant differences in spatial distribution sharing the same CAD-RADS classification.
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Li J, Wang L, Wang Q, Xin Z, Liu Y, Zhao Q. Diagnostic value of carotid artery ultrasound and hypersensitive C-reactive protein in Type 2 diabetes mellitus patients with acute myocardial infarction in Chinese population. Medicine (Baltimore) 2018; 97:e12334. [PMID: 30313029 PMCID: PMC6203565 DOI: 10.1097/md.0000000000012334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Hypersensitive C-reactive protein (hs-CRP) is reported to be significant risk indicators not only for the development of cardiovascular disease, but also for the development or progression of type 2 diabetes. The objective of this study was to analyze the significance of hs-CRP in type 2 diabetes mellitus (T2DM) combined with acute myocardial infarction (AMI).Fifty patients with both T2DM and AMI, 50 patients with T2DM alone, and 50 healthy subjects (control group) were selected.Operating characteristic (ROC) analysis revealed that the sensitivity, specificity, accuracy, and critical value in the diagnosis of T2DM combined with AMI using hs-CRP level were 84.6%, 75.9%, 0.856, and 7.34 mg/L, respectively. For using vulnerable plaque rate, these were 92.7%, 95.3%, 0.923, and 0.52, respectively.hs-CRP play a significant role in the early diagnosis of T2DM combined with AMI.
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Affiliation(s)
- Juan Li
- Special Inspection Department
| | - Liangliang Wang
- Ultrasound Department, Liaocheng People's Hospital, Shandong, China
| | - Qian Wang
- Ultrasound Department, Liaocheng People's Hospital, Shandong, China
| | - Zhaoqin Xin
- Ultrasound Department, Liaocheng People's Hospital, Shandong, China
| | | | - Qinghua Zhao
- Ultrasound Department, Liaocheng People's Hospital, Shandong, China
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