Author + information
- Tetsumin Lee1,
- Gary Mintz2,
- Mitsuaki Matsumura2,
- Masahiro Hoshino3,
- Eisuke Usui3,
- Yoshihisa Kanaji4,
- Tadashi Murai3,
- Taishi Yonetsu3,
- Tsunekazu Kakuta3 and
- Akiko Maehara2
Although intraplaque hemorrhage (IPH) has been reported to be one of the major causes of lesion progression, the pattern of IPH by intravascular ultrasound (IVUS) and/or optical coherence tomography (OCT) is unknown.
We hypothesized that IPH could be defined as a superficial organized thrombus by IVUS with the corresponding OCT image showing a convex smooth-shaped surface of lipidic plaque without fibrous cap disruption (Figure). A total of 596 pts (533 stable and 63 troponin negative acute coronary syndromes) were evaluated by both IVUS and OCT before PCI.
The pre-specified IPH pattern was observed in 64 pts (10.7%) who had more diabetes mellitus and a higher CRP. Lesions with the IVUS/OCT IPH pattern were more often in the RCA with more OCT-defined unstable features (thin cap fibroatheroma, plaque rupture, thrombus or greater plaque burden) not at IPH site compared to those without IPH (Table). Both angiographic slow flow (14.1% vs 2.4%, p < 0.01) and SCAI definition periprocedural myocardial infarction (9.4% vs 1.5%, p < 0.01) were significantly more prevalent in lesions with vs without IPH.
|Lesions with IPH (n = 64)||Lesions without IPH (n = 532)||p-value|
|CRP, mg/dL||0.17 (0.06, 0.53)||0.08 (0.00, 0.22)||<0.01|
|Minimum lumen area, mm2||2.07 (1.78, 2.53)||2.12 (1.81, 2.69)||0.37|
|Plaque burden at minimum lumen area site, %||88.5 (84.8, 91.0)||83.7 (78.8, 87.5)||<0.01|
There was a distinct pattern of IPH evident by combining IVUS and OCT that was related to unstable plaque morphology and adverse peri-procedural acute outcomes.
IMAGING: Imaging: Intravascular