Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction

Jun ichi Kotani, Gary S. Mintz, Marco T. Castagna, Ellen Pinnow, Chalak O. Berzingi, Anh B. Bui, Augusto D. Pichard, Lowell F. Satler, William O. Suddath, Ron Waksman, John R. Laird, Kenneth M. Kent, Neil J. Weissman

Research output: Contribution to journalArticle

163 Citations (Scopus)

Abstract

Background - Previous studies have reported diffuse destabilization of atherosclerotic plaques in acute myocardial infarction (AMI). Methods and Results - We used intravascular ultrasound (IVUS) to assess 78 coronary arteries (38 infarct-related arteries [IRAs] with culprit and nonculprit lesions and 40 non-IRAs) from 38 consecutive AMI patients. IVUS analysis included qualitative and quantitative measurements of reference and lesion external elastic membrane (EEM), lumen, and plaque plus media (P&M) area. Positive remodeling was defined as lesion/mean reference EEM > 1.0. Culprit lesions were identified by a combination of ECG, wall motion abnormalities (ventriculogram or echocardiogram), scintigraphic perfusion defects, and coronary angiogram. Culprit lesions contained more thrombus (23.7% versus 3.4% in nonculprit IRA plaques and 3.1% in non-IRA plaques; P=0.0011). Culprit lesions were predominantly hypoechoic (63.2% versus 37.9% of nonculprit IRA plaques and 28.1% of non-IRA plaques; P=0.0022). Culprit lesions were longer (17.5±10.1, 9.8±4.0, and 10.3±5.7 mm, respectively; P<0.0001), had larger EEM area (15.0±6.0, 11.5±5.7, and 12.6±5.6 mm2, respectively; P=0.0353) and P&M area (13.0±6.0, 7.5±3.7, 9.3±4.3 mm2, respectively; P<0.0001), smaller lumens (2.0±0.9, 4.1±3.1, and 3.4±2.5 mm2, respectively; P=0.0009), and more positive remodeling (79.4%, 59.0%, and 50.8%, respectively; P=0.0155). The frequency of plaque rupture/dissection was greater in culprit, nonculprit IRA, and non-IRA plaques in AMI patients than in a control group of chronic stable angina patients with multivessel IVUS imaging. Conclusions - Culprit plaques have more markers of instability (thrombus, positive remodeling, and large plaque mass); however, these markers of instability are not typically found elsewhere. This suggests that the vascular event in AMI patients is determined by local pre-event lesion morphologies.

Original languageEnglish (US)
Pages (from-to)2889-2893
Number of pages5
JournalCirculation
Volume107
Issue number23
DOIs
StatePublished - Jun 17 2003
Externally publishedYes

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Arteries
Myocardial Infarction
Membranes
Thrombosis
Stable Angina
Atherosclerotic Plaques
Blood Vessels
Dissection
Rupture
Ultrasonography
Coronary Vessels
Angiography
Electrocardiography
Perfusion
Control Groups

Keywords

  • Myocardial infarction
  • Plaque
  • Ultrasonics

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Kotani, J. I., Mintz, G. S., Castagna, M. T., Pinnow, E., Berzingi, C. O., Bui, A. B., ... Weissman, N. J. (2003). Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction. Circulation, 107(23), 2889-2893. https://doi.org/10.1161/01.CIR.0000072768.80031.74

Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction. / Kotani, Jun ichi; Mintz, Gary S.; Castagna, Marco T.; Pinnow, Ellen; Berzingi, Chalak O.; Bui, Anh B.; Pichard, Augusto D.; Satler, Lowell F.; Suddath, William O.; Waksman, Ron; Laird, John R.; Kent, Kenneth M.; Weissman, Neil J.

In: Circulation, Vol. 107, No. 23, 17.06.2003, p. 2889-2893.

Research output: Contribution to journalArticle

Kotani, JI, Mintz, GS, Castagna, MT, Pinnow, E, Berzingi, CO, Bui, AB, Pichard, AD, Satler, LF, Suddath, WO, Waksman, R, Laird, JR, Kent, KM & Weissman, NJ 2003, 'Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction', Circulation, vol. 107, no. 23, pp. 2889-2893. https://doi.org/10.1161/01.CIR.0000072768.80031.74
Kotani, Jun ichi ; Mintz, Gary S. ; Castagna, Marco T. ; Pinnow, Ellen ; Berzingi, Chalak O. ; Bui, Anh B. ; Pichard, Augusto D. ; Satler, Lowell F. ; Suddath, William O. ; Waksman, Ron ; Laird, John R. ; Kent, Kenneth M. ; Weissman, Neil J. / Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction. In: Circulation. 2003 ; Vol. 107, No. 23. pp. 2889-2893.
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abstract = "Background - Previous studies have reported diffuse destabilization of atherosclerotic plaques in acute myocardial infarction (AMI). Methods and Results - We used intravascular ultrasound (IVUS) to assess 78 coronary arteries (38 infarct-related arteries [IRAs] with culprit and nonculprit lesions and 40 non-IRAs) from 38 consecutive AMI patients. IVUS analysis included qualitative and quantitative measurements of reference and lesion external elastic membrane (EEM), lumen, and plaque plus media (P&M) area. Positive remodeling was defined as lesion/mean reference EEM > 1.0. Culprit lesions were identified by a combination of ECG, wall motion abnormalities (ventriculogram or echocardiogram), scintigraphic perfusion defects, and coronary angiogram. Culprit lesions contained more thrombus (23.7{\%} versus 3.4{\%} in nonculprit IRA plaques and 3.1{\%} in non-IRA plaques; P=0.0011). Culprit lesions were predominantly hypoechoic (63.2{\%} versus 37.9{\%} of nonculprit IRA plaques and 28.1{\%} of non-IRA plaques; P=0.0022). Culprit lesions were longer (17.5±10.1, 9.8±4.0, and 10.3±5.7 mm, respectively; P<0.0001), had larger EEM area (15.0±6.0, 11.5±5.7, and 12.6±5.6 mm2, respectively; P=0.0353) and P&M area (13.0±6.0, 7.5±3.7, 9.3±4.3 mm2, respectively; P<0.0001), smaller lumens (2.0±0.9, 4.1±3.1, and 3.4±2.5 mm2, respectively; P=0.0009), and more positive remodeling (79.4{\%}, 59.0{\%}, and 50.8{\%}, respectively; P=0.0155). The frequency of plaque rupture/dissection was greater in culprit, nonculprit IRA, and non-IRA plaques in AMI patients than in a control group of chronic stable angina patients with multivessel IVUS imaging. Conclusions - Culprit plaques have more markers of instability (thrombus, positive remodeling, and large plaque mass); however, these markers of instability are not typically found elsewhere. This suggests that the vascular event in AMI patients is determined by local pre-event lesion morphologies.",
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TY - JOUR

T1 - Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction

AU - Kotani, Jun ichi

AU - Mintz, Gary S.

AU - Castagna, Marco T.

AU - Pinnow, Ellen

AU - Berzingi, Chalak O.

AU - Bui, Anh B.

AU - Pichard, Augusto D.

AU - Satler, Lowell F.

AU - Suddath, William O.

AU - Waksman, Ron

AU - Laird, John R.

AU - Kent, Kenneth M.

AU - Weissman, Neil J.

PY - 2003/6/17

Y1 - 2003/6/17

N2 - Background - Previous studies have reported diffuse destabilization of atherosclerotic plaques in acute myocardial infarction (AMI). Methods and Results - We used intravascular ultrasound (IVUS) to assess 78 coronary arteries (38 infarct-related arteries [IRAs] with culprit and nonculprit lesions and 40 non-IRAs) from 38 consecutive AMI patients. IVUS analysis included qualitative and quantitative measurements of reference and lesion external elastic membrane (EEM), lumen, and plaque plus media (P&M) area. Positive remodeling was defined as lesion/mean reference EEM > 1.0. Culprit lesions were identified by a combination of ECG, wall motion abnormalities (ventriculogram or echocardiogram), scintigraphic perfusion defects, and coronary angiogram. Culprit lesions contained more thrombus (23.7% versus 3.4% in nonculprit IRA plaques and 3.1% in non-IRA plaques; P=0.0011). Culprit lesions were predominantly hypoechoic (63.2% versus 37.9% of nonculprit IRA plaques and 28.1% of non-IRA plaques; P=0.0022). Culprit lesions were longer (17.5±10.1, 9.8±4.0, and 10.3±5.7 mm, respectively; P<0.0001), had larger EEM area (15.0±6.0, 11.5±5.7, and 12.6±5.6 mm2, respectively; P=0.0353) and P&M area (13.0±6.0, 7.5±3.7, 9.3±4.3 mm2, respectively; P<0.0001), smaller lumens (2.0±0.9, 4.1±3.1, and 3.4±2.5 mm2, respectively; P=0.0009), and more positive remodeling (79.4%, 59.0%, and 50.8%, respectively; P=0.0155). The frequency of plaque rupture/dissection was greater in culprit, nonculprit IRA, and non-IRA plaques in AMI patients than in a control group of chronic stable angina patients with multivessel IVUS imaging. Conclusions - Culprit plaques have more markers of instability (thrombus, positive remodeling, and large plaque mass); however, these markers of instability are not typically found elsewhere. This suggests that the vascular event in AMI patients is determined by local pre-event lesion morphologies.

AB - Background - Previous studies have reported diffuse destabilization of atherosclerotic plaques in acute myocardial infarction (AMI). Methods and Results - We used intravascular ultrasound (IVUS) to assess 78 coronary arteries (38 infarct-related arteries [IRAs] with culprit and nonculprit lesions and 40 non-IRAs) from 38 consecutive AMI patients. IVUS analysis included qualitative and quantitative measurements of reference and lesion external elastic membrane (EEM), lumen, and plaque plus media (P&M) area. Positive remodeling was defined as lesion/mean reference EEM > 1.0. Culprit lesions were identified by a combination of ECG, wall motion abnormalities (ventriculogram or echocardiogram), scintigraphic perfusion defects, and coronary angiogram. Culprit lesions contained more thrombus (23.7% versus 3.4% in nonculprit IRA plaques and 3.1% in non-IRA plaques; P=0.0011). Culprit lesions were predominantly hypoechoic (63.2% versus 37.9% of nonculprit IRA plaques and 28.1% of non-IRA plaques; P=0.0022). Culprit lesions were longer (17.5±10.1, 9.8±4.0, and 10.3±5.7 mm, respectively; P<0.0001), had larger EEM area (15.0±6.0, 11.5±5.7, and 12.6±5.6 mm2, respectively; P=0.0353) and P&M area (13.0±6.0, 7.5±3.7, 9.3±4.3 mm2, respectively; P<0.0001), smaller lumens (2.0±0.9, 4.1±3.1, and 3.4±2.5 mm2, respectively; P=0.0009), and more positive remodeling (79.4%, 59.0%, and 50.8%, respectively; P=0.0155). The frequency of plaque rupture/dissection was greater in culprit, nonculprit IRA, and non-IRA plaques in AMI patients than in a control group of chronic stable angina patients with multivessel IVUS imaging. Conclusions - Culprit plaques have more markers of instability (thrombus, positive remodeling, and large plaque mass); however, these markers of instability are not typically found elsewhere. This suggests that the vascular event in AMI patients is determined by local pre-event lesion morphologies.

KW - Myocardial infarction

KW - Plaque

KW - Ultrasonics

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