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Impact of tissue protrusion after coronary stenting in patients with ST-segment elevation myocardial infarction Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease A Special Report From the American Heart Association and American College of Cardiolog Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease Decade-Long Trends (2001 to 2011) in the Use of Evidence-Based Medical Therapies at the Time of Hospital Discharge for Patients Surviving Acute Myocardial Infarction Classic crush and DK crush stenting techniques Comparison of Inhospital Mortality and Frequency of Coronary Angiography on Weekend Versus Weekday Admissions in Patients With Non-ST-Segment Elevation Acute Myocardial Infarction Coronary CT Angiography and 5-Year Risk of Myocardial Infarction Short-Term Progression of Multiterritorial Subclinical Atherosclerosis
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Original Research2019 Mar;35(3):401-407.

JOURNAL：Int J Cardiovasc Imaging. Article Link

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

Okuya Y, Saito Y, Sakai Y et al. Keywords: ntravascular ultrasound; Prognosis; ST-segment elevation myocardial infarction; Tissue protrusion

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 coronaryflow 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.

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