Meta-Analysis of Plaque Composition by Intravascular Ultrasound and Its Relation to Distal Embolization After Percutaneous Coronary Intervention

Controversies exist regarding the association between plaque composition and distal embolization phenomenon after percutaneous coronary intervention (PCI). We evaluated the effect of plaque characteristics on embolization after PCI by grayscale and virtual histology-intravascular ultrasound (IVUS)....

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Published in:The American journal of cardiology 2013-04, Vol.111 (7), p.968-972
Main Authors: Jang, Jae-Sik, MD, PhD, Jin, Han-Young, MD, Seo, Jeong-Sook, MD, PhD, Yang, Tae-Hyun, MD, PhD, Kim, Dae-Kyeong, MD, PhD, Park, Young-Ah, MD, Cho, Kyoung-Im, MD, PhD, Park, Yong Hyun, MD, PhD, Kim, Dong-Soo, MD, PhD
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Asymmetry
Cardiology
Cardiovascular
Confidence intervals
Coronary Artery Disease - diagnostic imaging
Coronary Artery Disease - pathology
Coronary Artery Disease - therapy
Embolization, Therapeutic
Heart attacks
Histology
Humans
Necrosis
Percutaneous Coronary Intervention
Plaque, Atherosclerotic - diagnostic imaging
Plaque, Atherosclerotic - pathology
Plaque, Atherosclerotic - therapy
Sensitivity analysis
Ultrasonography, Interventional
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Summary:Controversies exist regarding the association between plaque composition and distal embolization phenomenon after percutaneous coronary intervention (PCI). We evaluated the effect of plaque characteristics on embolization after PCI by grayscale and virtual histology-intravascular ultrasound (IVUS). We searched PubMed, Ovid MEDLINE, and Cochrane databases for IVUS studies evaluating the coronary plaque characteristics in no reflow, distal embolization, and periprocedural myocardial infarction after PCI. Sixteen studies were included, totaling 1,697 patients who underwent PCI (292 patients with embolization and 1,405 patients without embolization). At the minimum lumen sites, the external elastic membrane (weighted mean difference 2.38 mm2 , 95% confidence interval [CI] 1.02 to 3.74) and the plaque and media cross-sectional areas (weighted mean difference 2.44 mm2 , 95% CI 1.44 to 3.45) were significantly greater in the embolization group than in the no embolization group. Pooled analysis showed that the absolute necrotic core volume (standardized mean difference 0.49, 95% CI 0.13 to 0.85), absolute (standardized mean difference 0.73, 95% CI 0.14 to 1.31) and relative (standardized mean difference 1.02, 95% CI 0.72 to 1.31) necrotic core areas at the minimum lumen sites were significantly greater in the embolization group than in the no embolization group, but the other plaque components were similar in the 2 groups. In conclusion, the necrotic core component derived from virtual histology-IVUS and the morphologic characteristics of plaque derived from grayscale IVUS are closely related to the distal embolization phenomenon after PCI.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2012.12.016