Coronary plaque redistribution after stent implantation is determined by lipid composition: A NIRS-IVUS analysis.

BACKGROUND: The composition of plaque impacts the results of stenting. The following study evaluated plaque redistribution related to stent implantation using combined near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS) imaging. METHODS: The present study included 49 patients (mean age 66 ± 11 years, 75% males) presenting with non-ST elevation myocardial infarction (8%), unstable angina (49%) and stable coronary artery disease (43%). The following parameters were analyzed: mean plaque volume (MPV, mm3), plaque burden (PB, %), remodeling index (RI), and maximal lipid core burden index in a 4 mm segment (maxLCBI4mm). High-lipid burden lesions (HLB) were defined as by maxLCBI4mm > 265 with positive RI. Otherwise plaques were defined as low-lipid burden lesions (LLB). Measurements were done in the target lesion and in 4 mm edges of the stent before and after stent implantation. RESULTS: MPV and maxLCBI4mm decreased in both HLB (MPV 144.70 [80.47, 274.25] vs. 97.60 [56.82, 223.45]; maxLCBI4mm: 564.11 ± 166.82 vs. 258.11 ± 234.24, p = 0.004) and LLB (MPV: 124.50 [68.00, 186.20] vs. 101.10 [67.87, 165.95]; maxLCBI4mm: 339.07 ± 268.22 vs. 124.60 ± 160.96, p < 0.001), but MPV decrease was greater in HLB (28.00 [22.60, 57.10] vs. 13.50 [1.50, 28.84], p = 0.019). Only at the proximal stent edge of LLB, maxLCBI4mm decreased (34 [0, 207] vs. 0 [0, 45], p = 0.049) and plaque burden increased (45.48 [40.34, 51.55] vs. 51.75 [47.48, 55.76], p = 0.030). CONCLUSIONS: NIRS-IVUS defined HLB characterized more significant decreases in plaque volume by stenting. Plaque redistribution to the proximal edge of the implanted stent occurred only in LLB.

Optical Coherence Tomography of De Novo Lesions and In-Stent Restenosis in Coronary Saphenous Vein Grafts (OCTOPUS Study).

BACKGROUND: The OCTOPUS registry prospectively evaluates the procedural and long-term outcomes of saphenous vein graft (SVG) PCI. The current study assessed the morphology of de novo lesions and in-stent restenosis (ISR) in patients undergoing PCI of SVG. METHODS AND RESULTS: Optical coherence tomography (OCT) of SVG lesions in consecutive patients presenting with stable CAD and ACS was carried out. Thirty-nine patients (32 de novo and 10 ISR lesions) were included in the registry. ISR occurred in 5 BMS and 5 DES. There were no differences in the presence of plaque rupture and thrombus between de novo lesions and ISR. Lipid-rich tissue was identified in both de novo lesions and in ISR (75% vs. 50%, P=0.071) with a higher prevalence in BMS than in DES (23% vs. 7.5%; P=0.048). Calcific de novo lesions were detected in older grafts as compared with non-calcific atheromas (159±57 vs. 90±62 months after CABG, P=0.001). Heterogeneous neointima was found only in ISR (70% vs. 0, P<0.001) and was observed with similar frequency in both BMS and DES (24% vs. 30%, P=0.657). ISR was detected earlier in DES than BMS (median, 50 months; IQR, 18-96 months vs. 27 months; IQR, 13-29 months, P<0.001). CONCLUSIONS: OCT-based characteristics of de novo and ISR lesions in SVG were similar except for heterogeneous tissue, which was observed only in ISR. (Circ J 2016; 80: 1804-1811).

[Risk factors of death or re-hospitalization in acute coronary syndrome patients before and after earlier heart revascularization]. / Czynniki ryzyka zgonu lub ponownej hospitalizacji chorych z ostrym zespolem wiencowym przed i po uprzedniej rewaskularyzacji miesnia sercowego.

UNLABELLED: Cardiovascular diseases including coronary artery disease and its complications--acute coronary syndromes (ACS) are the leading causes of mortality in developed countries. With the growing number of percutaneous revascularization procedures (PCI) patients with at least one prior revascularization procedure constitute a growing population. The aim of the study was to define the predictors of death and rehospitalization of patients treated for ACS before and after earlier heart revascularization. MATERIAL AND METHODS: The study group consisted of 325 patients admitted with the ACS symptoms, 147 patients with prior PCI, 28 patients with former surgical revascularization and 150 patients with no prior coronary artery revascularization procedure. Case-history acquisition, physical examination, ECG, ultrasound echocardiography, coronary angiography and angioplasty of the ACS related vessel as well as the laboratory assessment of morphology, creatinine, sodium, potassium, glucose, troponine I, creatine kinase and its MB isoenzyme serum levels were performed in all cases. RESULTS: The study revealed that cardiogenic shock at the baseline, non-successful PCI procedure, impaired < 45% left ventricle ejection fraction were the independent predictors for death or re-hospitalization due to ACS onset. CONCLUSIONS: Even though ACS patients with prior revascularization history have worse echocardiographic parameters which have determined prognostic value, compared with patients with no prior revascularization the prognosis for the 6-month follow-up in both groups remains comparable.

[The impact of prior revascularization procedures on outcome of percutaneous coronary intervention in ACS]. / Wplyw uprzedniej rewaskularyzacji miesnia sercowego na wyniki leczenia interwencyjnego ostrych zespolów wiencowych.

UNLABELLED: Development of interventional cadriology is cause of increasing number of acute coronary syndrome (ACS) patients with prior revascularization procedures in the past. THE AIM OF THE STUDY: To evaluate the clinical feature of ACS patients with and without prior revascularization procedures and to compare in-hospital and long-term outcome following percutaneous coronary intervention (PCI) in these groups. MATERIAL AND METHODS: There were 325 ACS consecutive patients included to the study who underwent PCI procedures. There were 175 patients after PCI or coronary artery by-pass grafting in the past. Control group consisted of 150 subjects with ACS with no history of PCI procedures. We analyzed baseline characteristic as well as the inhospital, 30- and 180-day outcomes. RESULTS: The baseline characteristic revealed higher rate of patients with heart failure in case-history (18.0% vs. 26.9%, p = 0.03), diabetes (16.0% vs. 25.1%, p = 0.04), and multi-vessels coronary disease (85.2% vs. 60.6%, p = 0.003) in the subgroup of prior revascularization. The rate of non-STEMI was higher (28.0% vs. 40.6%, p = 0.02) and the rate of STEMI was lower (47.4% vs. 63.3%, p = 0.004) as a form of ACS in previously revascularized subjects. The analysis of inhospital outcome revealed significantly longer time of hospitalization of the patients with prior revascularization (7.7 +/- 4.6 vs. 5.4 +/- 4.1, p < 0.0001). There were no significant differences in clinical characteristics at 6-months after ACS. CONCLUSION: Patients undergoing PCI in ACS with prior revascularization procedures are characterized by a higher level of atherosclerosis risk factors, more advanced changes in coronary arteries and higher NSTEMI occurance than ACS patients without PCI history. Baseline and long-term results of revascularization, frequency and nature of complications are comparable in both groups, but length of hospitalization period and significantly longer in patients with revascularization in the past.