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Impact of atherosclerotic plaque composition on coronary microembolization during percutaneous coronary interventions

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Abstract

Background

Cardiac marker release after percutaneous coronary interventions (PCI) reflects myocardial necrosis which is usually the result of periprocedural (micro)embolization of atherothrombotic debris and associated with impaired left ventricular function and adverse outcome.

Methods

In this prospective study, we examined 55 patients treated by direct stenting of single de-novo lesions to assess the relationship between plaque composition, as determined by preinterventional intravascular ultrasound (IVUS) with radiofrequency data (IVUS-RF) analysis (so-called Virtual Histology) versus coronary microembolization, as determined by serial measurement of cardiac markers. IVUS was performed with an electronic system and 20-MHz IVUS catheters. Serum creatine kinase (CK) and cardiac troponin I (CTnI) were determined before PCI and after 6, 12, and 24 hours.

Results

Plaques had a volume of 99 ± 63 mm3 and were composed of fibrous (61 ± 9%) and fibro-fatty tissue (27 ± 12%), dense calcium (4 ± 3%), and necrotic core (NC) (8 ± 6%). NC volume per se, volume per 10 mm of segment length, and volume % were correlated (r = 0.64, 0.66, and 0.52 respectively; all P < 0.01) with the maximum increase in cardiac markers (CK 55.4 ± 55.7 U/l; CTnI 0.49 ± 0.68 ng/ml). Patients in the 4th quartile of NC volume (>10.8 mm3) had a particularly high increase in markers (P < 0.001). In contrast, total plaque volume and plaque components other than NC had no relation with cardiac markers (ns).

Conclusions

Patients with large NC in culprit lesions may experience more myocardial injury from peri-interventional microembolization. IVUS-RF assessment before PCI has the potential to identify lesions at particular high risk which may help to tailor PCI.

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Acknowledgments

We thank VIBGYOR™ Scientific Research Pvt Ltd. for their support. We thank Dr. N. Lehmann for the statistical support.

Conflict of interest R. Erbel was consultant for Volcano Corp. (Rancho Cordova, US). The other authors have no potential conflict of interest.

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Authors and Affiliations

  1. Dept. of Cardiology, West German Heart Center, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany

    Dirk Böse MD, Xiu Ying Zhou MD, Sebastian Philipp MD, Stefan Sack MD, Thomas Konorza MD, Stefan Möhlenkamp MD & Raimund Erbel MD

  2. Dept. of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands

    Clemens von Birgelen MD, PhD

  3. Institute for Biomedical Technology, University of Twente, Enschede, The Netherlands

    Clemens von Birgelen MD, PhD

  4. Dept. of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany

    Axel Schmermund MD

  5. Dept. of Pathophysiology, University of Duisburg-Essen, Essen, Germany

    Kirsten Leineweber PhD, Petra Kleinbongard PhD & Gerd Heusch MD, PhD

  6. Dept. of Cardiology, Cardiovascular Centre, Aalst, Belgium

    William Wijns MD, PhD

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  1. Dirk Böse MD
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  2. Clemens von Birgelen MD, PhD
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Correspondence to Dirk Böse MD.

Additional information

Returned for 1. Revision: 11 January 2008 1. Revision received: 23 July 2008

H.R. Figulla, Jena, Germany served as guest editor for the manuscript and was responsible for all editorial decisions, including the selection of reviewers. The policy applies to all manuscripts with authors from the editor’s institution.

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Böse, D., von Birgelen, C., Zhou, X.Y. et al. Impact of atherosclerotic plaque composition on coronary microembolization during percutaneous coronary interventions. Basic Res Cardiol 103, 587–597 (2008). https://doi.org/10.1007/s00395-008-0745-9

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