Korean Circ J.  2012 Jan;42(1):33-39. 10.4070/kcj.2012.42.1.33.

Fibro-Fatty Component is Important for the Long-Term Clinical Events in Patients Who Have Undergone Primary Percutaneous Coronary Intervention

• Kim WH
• Park HW
• Kim KH
• Song IG
• Yang DJ
• Lee CS
• Seo YH
• Kwon TG
• Bae JH

• KMID: 2297905
• DOI: http://doi.org/10.4070/kcj.2012.42.1.33

Abstract

BACKGROUND AND OBJECTIVES
We evaluated which plaque components are associated with long-term clinical events in patients who underwent primary percutaneous coronary intervention (PCI).
SUBJECTS AND METHODS
The study subjects consisted of 57 consecutive patients (mean age, 58.5+/-14.5 years; 45 males) who underwent primary PCI and a virtual histology-intravascular ultrasound examination. Major adverse cardiac events (MACEs) including death, acute myocardial infarction, stroke, and revascularization were evaluated during the mean 28 month follow-up period.
RESULTS
Patients with high fibro-fatty volume (FFV >13.4 mm3, n=29; mean age, 61.3 years) had a lower ejection fraction (52.7% vs. 59.4%, p=0.022), a higher incidence of multi-vessel disease (69.0% vs. 28.6%, p=0.002), larger plaque area (25.7 mm2 vs. 15.9 mm2, p<0.001), and larger plaque volume (315 mm3 vs. 142 mm3, p<0.001) than those with a low FFV (< or =13.4 mm3, n=28; mean age, 55.6 years). Patients with high FFV had a significantly higher incidence (32.1% vs. 8.3%, p=0.036) of MACE than those with low FFV. When we divided the study population according to the necrotic core volume (NCV), fibrous volume, or dense calcified volume, no significant findings in terms of demographics and MACE rates were observed. A Cox regression analysis revealed that the independent factor for MACE was FFV (hazard ratio, 6.748; 95% confidence interval, 1.168-38.971, p=0.033) in this study population.
CONCLUSION
The coronary plaque component, particularly FFV, but not NCV, was important in long-term clinical outcomes in patients who underwent primary PCI.

Keyword

Intravascular ultrasonography; Myocardial infarction; Disease-free survival

MeSH Terms

Demography
Disease-Free Survival
Follow-Up Studies
Humans
Incidence
Myocardial Infarction
Percutaneous Coronary Intervention
Stroke
Ultrasonography, Interventional

Figure

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  Fig. 1 Kaplan-Meier survival curve. Low FFV ≤13.4 mm3; high FFV >13.4 mm3. MACE: major adverse cardiac events, FFV: fibrofatty volume, AMI: acute myocardial infarction, PCI: percutaneous coronary intervention, TLR: target lesion revascularization.

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  Fig. 2 Area under the curve. FFV: fibrofatty volume.

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