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Impact of tissue protrusion after coronary stenting in patients with ST-segment elevation myocardial infarction

  • Yoshiyuki OkuyaEmail author
  • Yuichi Saito
  • Yoshiaki Sakai
  • Iwao Ishibashi
  • Yoshio Kobayashi
Original Paper

Abstract

Clinical impact of tissue protrusion (TP) after coronary stenting is still controversial, especially in patients with ST-segment elevation myocardial infarction (STEMI). A total of 104 STEMI patients without previous MI who underwent primary percutaneous coronary intervention (PCI) under intravascular ultrasound (IVUS)-guidance were included. Post-stenting grayscale IVUS analysis was performed, and the patients were classified according to the presence or absence of post-stenting TP on IVUS. Coronary angiography and single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) with 99mTc tetrofosmin were analyzed. Major adverse cardiac events were defined as cardiovascular death, myocardial infarction, heart failure hospitalization, and target vessel revascularization. TP on IVUS was detected in 62 patients (60%). Post-PCI coronary flow was more impaired, and peak creatine kinase-myoglobin binding level was higher in patients with TP compared to those without. SPECT MPI was performed in 77 out of 104 patients (74%) at 35.4 ± 7.7 days after primary PCI. In patients with TP, left ventricular ejection fraction was significantly reduced (47.5 ± 12.0% vs. 57.6 ± 11.2%, p < 0.001), and infarct size was larger [17% (8–25) vs. 4% (0–14), p = 0.002] on SPECT MPI. During a median follow-up of 14 months after primary PCI, Kaplan–Meier analysis demonstrated a significantly higher incidence of major adverse cardiac events in patients with TP compared to those without. TP on IVUS after coronary stenting was associated with poor outcomes in patients with STEMI.

Keywords

Intravascular ultrasound Tissue protrusion ST-segment elevation myocardial infarction Prognosis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Yoshiyuki Okuya
    • 1
    Email author
  • Yuichi Saito
    • 2
  • Yoshiaki Sakai
    • 1
  • Iwao Ishibashi
    • 1
  • Yoshio Kobayashi
    • 2
  1. 1.Department of Cardiovascular MedicineChiba Emergency Medical CenterChibaJapan
  2. 2.Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan

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