- 著者
- Ryotaro Yamada Hiroyuki Okura Teruyoshi Kume Yoji Neishi Takahiro Kawamoto Yoshinori Miyamoto Koichiro Imai Ken Saito Tetsuo Tsuchiya Akihiro Hayashida Kiyoshi Yoshida
- 出版者
- The Japanese Circulation Society
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- vol.74, no.8, pp.1658-1662, 2010 (Released:2010-07-23)
- 参考文献数
- 30
- 被引用文献数
- 18 16
Background: Several reports suggest that virtual histology intravascular ultrasound (VH-IVUS) assessment could predict microvascular damage during percutaneous coronary intervention (PCI). A novel index of microcirculatory resistance (IMR) has been developed as a reproducible and less hemodynamic-dependent index. The purpose of this study was to investigate the relationship between thin-cap fibroatheroma (TCFA) defined by VH-IVUS and a change in the IMR during PCI in patients with angina pectoris (AP). Methods and Results: The study investigated 30 lesions from 28 AP patients. VH-IVUS imaging was performed before PCI. TCFA was defined as the presence of confluent necrotic core (>10%) without detectable overlying fibrous cap segment. Patients were divided into 2 groups according to the presence of TCFA. Using a pressure guidewire, IMR were measured before and after PCI. After successful PCI, patients were prospectively followed up clinically. TCFA was detected in 9 lesions (30%). IMR tended to improve after PCI in the non-TCFA group, but tended to worsen in the TCFA group. ΔIMR (=IMR after PCI-IMR before PCI) was significantly higher in the TCFA group compared with the non-TCFA group (13.2±29.9 vs -4.4±16.0, P=0.04). During follow-up (mean 20 months), survival free of major adverse cardiac events was significantly less in the TCFA group than in the non-TCFA group. Conclusions: Target lesion TCFA may be related to both microvascular injury and the long-term clinical outcome after successful PCI in patients with AP. (Circ J 2010; 74: 1658 - 1662)