Premium
Tissue characterization and phenotype classification in patients presenting with acute myocardial infarction: Insights from the iWonder study
Author(s) -
Souza Cristiano F.,
Maehara Akiko,
Mintz Gary S.,
Matsumura Mitsuaki,
Alves Claudia M.R.,
Carlos Carvalho Antonio,
Caixeta Adriano
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26954
Subject(s) - medicine , culprit , intravascular ultrasound , percutaneous coronary intervention , myocardial infarction , vulnerable plaque , cardiology , radiology , lesion , target lesion , pathological , pathology
Objectives We sought to assess a new modality of radiofrequency intravascular ultrasound (IVUS) called iMAP‐IVUS (Boston Scientific, Santa Clara, California) during the evaluation of patients presenting with high‐risk acute coronary syndromes. Background There are limited data on plaque tissue characterization and phenotype classification using iMAP‐IVUS. Methods In the iWonder study patients presenting with ST‐elevation myocardial infarction (STEMI) or non‐STEMI underwent three‐vessel grayscale IVUS and iMAP‐IVUS tissue characterization prior to percutaneous intervention. In total 385 lesions from 100 patients were divided into culprit ( n = 100) and nonculprit ( n = 285) lesions. Lesion phenotype was classified as (i) thin‐cap fibroatheroma (iMAP‐derived TCFA); (ii) thick‐cap fibroatheroma; (iii) pathological intimal thickening; (iv) fibrotic plaque; and (v) fibrocalcific plaque. Results Culprit lesions had smaller minimum lumen cross‐sectional area (MLA) with greater plaque burden compared to non‐culprit lesions. Volumetric analysis showed that culprit lesions had longer length and larger vessel and plaque volumes compared to non‐culprit lesions. iMAP‐IVUS revealed that culprit lesions presented more NC and fibrofatty volume, both at lesion level and at the MLA site (all P < 0.001). Any fibroatheroma was more frequently identified in culprit lesions compared with non‐culprit lesions (93% vs. 78.9%, P = 0.001), anywhere within the lesion 19.0%, P < 0.001) as well as at the MLA site (18.0% vs. 9.5%, P = 0.07). Conclusions Three‐vessel radiofrequency iMAP‐IVUS demonstrated a greater plaque burden and higher prevalence of any fibroatheroma as well as iMAP‐derived TCFAs in culprit versus non‐culprit lesions in patients presenting with STEMI or non‐STEMI undergoing percutaneous coronary intervention. © 2017 Wiley Periodicals, Inc.