Related Experiment Video
Updated: Jun 14, 2026
Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Effect of renal function on ultrasonic coronary plaque characteristics in patients with acute myocardial infarction
Young Joon Hong1, Myung Ho Jeong, Yun Ha Choi
1Heart Research Center, Chonnam National University Hospital, Gwangju, Korea.
Insights
Patients with acute myocardial infarction and reduced kidney function show increased plaque vulnerability and higher risks of adverse cardiac events. This highlights the importance of assessing renal function in managing heart attack patients.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Medical Imaging
Background:
- Renal dysfunction is a known risk factor for cardiovascular disease.
- The impact of varying degrees of renal dysfunction on coronary plaque characteristics and clinical outcomes in acute myocardial infarction (AMI) patients requires further investigation.
Purpose of the Study:
- To evaluate the relationship between creatinine clearance (CrCl) and coronary plaque morphology and morphometry in patients with AMI.
- To determine if CrCl is an independent predictor of culprit lesion plaque rupture and to assess the association between renal function and clinical outcomes following AMI.
Main Methods:
- Intravascular ultrasonography (IVUS) was used to assess plaque characteristics in 310 AMI patients stratified by CrCl levels (>70, 30-69, <30 ml/min).
- Plaque burden, lesion length, plaque rupture, thrombus presence, and ruptured plaque dimensions were analyzed.
- Clinical outcomes, including nonfatal myocardial infarction, cardiac death, and stent thrombosis, were tracked over a 1-year follow-up period.
Main Results:
- Patients with the lowest CrCl (<30 ml/min) exhibited significantly greater plaque burden, longer lesions, and a higher prevalence of plaque rupture, including multiple ruptures and larger ruptured plaque cavities.
- Intravascular ultrasound-detected thrombus was most frequent in the lowest CrCl group.
- Lower CrCl was an independent predictor of culprit lesion plaque rupture, and patients in the lowest CrCl group experienced the highest incidence of nonfatal myocardial infarction, cardiac death, and a trend towards increased stent thrombosis.
Conclusions:
- Patients with acute myocardial infarction and significant renal dysfunction demonstrate increased coronary plaque vulnerability.
- This heightened plaque vulnerability in the setting of renal dysfunction is associated with poorer clinical outcomes, including recurrent cardiovascular events.
- Assessment of renal function is crucial for risk stratification and management of patients with acute myocardial infarction.
Abstract:
We used intravascular ultrasonography to assess plaque morphology and morphometry in 310 patients with acute myocardial infarction (125 with ST-segment elevation and 185 with non-ST-segment elevation myocardial infarction) with varying degrees of renal dysfunction according to the creatinine clearance (CrCl): CrCl >70 ml/min in 153, CrCl of 30 to 69 ml/min in 103, and CrCl of <30 ml/min in 54 patients, including 20 patients requiring dialysis). The lesion site plaque burden was greatest (77.4 +/- 11.0% vs 79.8 +/- 12.5% vs 82.0 +/- 10.3%, p = 0.031) and the lesion was longest (20.9 +/- 9.1 vs 23.1 +/- 9.5 vs 26.3 +/- 9.6 mm, p = 0.038) in the lowest CrCl group. Infarct-related artery plaque rupture (31.4% vs 34.0% vs 53.7%, p = 0.011) and multiple plaque ruptures (11.1% vs 12.6% vs 33.3%, p <0.001) were the most common, the ruptured plaque cavities were the largest (1.98 +/- 0.89 vs 2.20 +/- 1.45 vs 3.06 +/- 1.70 mm(2), p = 0.002), and the ruptured plaque was longest (2.33 +/- 0.93 vs 2.59 +/- 1.50 vs 3.33 +/- 1.76 mm, p = 0.008) in the lowest CrCl group (<30 ml/min). Intravascular ultrasound-detected thrombus was observed most frequently in the lowest CrCl group (22.9% vs 23.3% vs 40.7%, p = 0.027). CrCl was the one of the independent predictors of culprit lesion plaque rupture (odds ratio 0.979, 95% confidence interval 0.963 to 0.994, p = 0.008). During 1 year of follow-up, the incidence of nonfatal myocardial infarction (2.6% vs 4.9% vs 11.1%, p = 0.044) and cardiac death (3.9% vs 6.8% vs 14.8%, p = 0.024) was greatest in the lowest CrCl group. Also, a strong trend was found toward the greatest incidence of stent thrombosis (2.0% vs 3.9% vs 9.3%, p = 0.057) in the lowest CrCl group. In conclusion, patients with acute myocardial infarction and significant renal dysfunction had more plaque vulnerability compared to those with normal renal function. This might be associated with poor clinical outcomes in patients with acute myocardial infarction and renal dysfunction.
Related Concept Videos
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Imaging Studies for Cardiovascular System V: CT
01:30Acute Coronary Syndrome I: Introduction