Positive remodeling is associated with more plaque vulnerability and higher frequency of plaque prolapse accompanied with post-procedural cardiac enzyme elevation compared with intermediate/negative remodeling in patients with acute myocardial infarction

• Published in: Journal of cardiology 2009-04, Vol.53 (2), p.278-287
• Main Authors: Hong, Young Joon, MD, Jeong, Myung Ho, MD, Choi, Yun Ha, RN, Ko, Jum Suk, MD, Lee, Min Goo, MD, Kang, Won Yu, MD, Lee, Shin Eun, MD, Kim, Soo Hyun, MD, Park, Keun Ho, MD, Sim, Doo Sun, MD, Yoon, Nam Sik, MD, Youn, Hyun Ju, MD, Kim, Kye Hun, MD, Park, Hyung Wook, MD, Kim, Ju Han, MD, Ahn, Youngkeun, MD, Cho, Jeong Gwan, MD, Park, Jong Chun, MD, Kang, Jung Chaee, MD
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Cardiovascular; Coronary Angiography; Coronary Thrombosis - pathology; Coronary Vessels - pathology; Female; Humans; Intravascular ultrasound; Male; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - enzymology; Myocardial Infarction - therapy; Plaque; Remodeling; Rupture, Spontaneous; Stents; Troponin I - blood; Ultrasonography, Interventional; Ventricular Remodeling - physiology
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2008.12.006

Summary Background We assessed the impact of remodeling patterns on pre- and post-procedural intravascular ultrasound (IVUS) findings and cardiac enzyme elevation after stenting in 310 acute myocardial infarction (AMI) patients. Methods The positive remodeling (PR) (PR group, n = 113 ) was defined as remodeling index (lesion/reference external elastic membrane cross-sectional area) >1.05, intermediate remodeling (IR) as between 0.95 and 1.05, and negative remodeling (NR) as < 0.95 (IR/NR group, n = 197 ). IVUS findings included ruptured plaque (a cavity that communicated with the lumen with an overlying residual fibrous cap fragment), multiple ruptured plaques (different plaque ruptures separated by a >5-mm length of artery containing smooth lumen contours), thrombus (discrete intraluminal filling defects), and plaque prolapse (tissue extrusion through the stent strut at post-stenting). We compared pre- and post-procedural IVUS findings and cardiac-specific troponin I (cTnI) elevation after stenting according to the remodeling pattern. Results The plaque rupture (60% vs. 42%, p = 0.004), multiple plaque ruptures (22% vs. 14%, p = 0.014), and IVUS-detected thrombus (42% vs. 28%, p = 0.012) were more common in the PR group compared with the IR/NR group. Post-stenting plaque prolapse was observed more frequently (36% vs. 22%, p = 0.008), and cTnI was elevated more significantly after stenting in the PR group compared with the IR/NR group (ΔcTnI; +7.8 ± 51.1 ng/ml vs. +0.9 ± 41.1 ng/ml, p = 0.008). Multivariate analysis showed that PR [odds ratio (OR) = 1.92; 95% CI 1.04–2.98, p = 0.028], plaque rupture (OR 1.98; 95% CI 1.16–3.45, p = 0.025), IVUS-detected thrombus (OR 2.30; 95% CI 1.22–3.98, p = 0.008), and plaque prolapse (OR 8.40; 95% CI 4.19–16.84, p < 0.001) were independently associated with post-stenting cTnI elevation. Conclusions AMI patients with PR have more plaque vulnerability and higher frequency of plaque prolapse accompanied by post-procedural cardiac enzyme elevation compared with AMI patients with IR/NR.