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Coronary Plaque Characteristics Affect No-Reflow During Primary Percutaneous Coronary Intervention: A Pooled Analysis
Bu-Chun Zhang, Cheng Wang, Zhi-Wen Zhou
1Department of Cardiology, The Affiliated Hospital of Xuzhou Medical College, Jiangsu 221002, China; Department of Cardiology, Shanghai Xuhui Central Hospital, Shanghai, China.
Insights
Percutaneous coronary intervention (PCI) no-reflow is linked to higher fibrofatty plaque volume and larger plaque area. Intravascular ultrasound (IVUS) data show specific plaque characteristics predict no-reflow, aiding intervention strategies.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- The no-reflow phenomenon complicates percutaneous coronary intervention (PCI).
- Coronary plaque composition's role in no-reflow remains debated.
- Intravascular ultrasound (IVUS) provides detailed plaque imaging.
Purpose of the Study:
- To systematically evaluate the association between coronary plaque characteristics and no-reflow after PCI.
- To synthesize evidence from IVUS studies using meta-analysis.
Main Methods:
- Systematic literature search of MEDLINE, Embase, Cochrane, and Ovid.
- Meta-analysis of 14 observational trials including 1457 patients.
- Analysis of plaque composition and arterial remodeling parameters detected by IVUS.
Main Results:
- No-reflow group showed significantly higher absolute volumes of fibrofatty plaque, external elastic membrane cross-sectional area (EEM-CSA), and plaque area.
- Higher artery remodeling index was observed in the no-reflow group.
- A significantly smaller percentage of fibrous plaque was found in patients experiencing no-reflow.
Conclusions:
- High absolute volume of fibrofatty plaque, EEM-CSA, plaque area, and artery remodeling index are associated with no-reflow post-PCI.
- A decreased percentage of fibrous plaque is a predictor of no-reflow.
- IVUS-detected plaque characteristics in culprit lesions can help predict no-reflow development.
Abstract:
The association between coronary plaque composition and no-reflow during percutaneous coronary intervention (PCI) is still debated. We performed a systematic literature search using MEDLINE, Embase, Cochrane, and Ovid databases for intravascular ultrasound (IVUS) studies evaluating the relationship between coronary plaque characteristics and no-reflow after PCI. Fourteen observational trials were included in the meta-analysis, including 1457 patients (237 in the no-reflow group, 1220 in the normal reflow group). Pooled analysis indicated that the no-reflow group had a significantly higher absolute volume of fibrofatty plaque (weighted mean differences [WMD], 4.94 mm(3); 95% confidence interval [CI], 1.83-l8.06; P = .002), external elastic membrane cross-sectional area (EEM-CSA) (WMD, 3.40 mm2; 95% CI, 2.22-4.58; P = .00001), plaque area (WMD, 4.06 mm(2); 95% CI, 2.24-5.89; P = .0001), and artery remodeling index (WMD, 0.09; 95% CI, 0.06-0.13; P = .00001), and a smaller percentage of fibrous plaque (WMD, -5.89 %; 95% CI, -0.66 to -11.12; P = .03) than in the normal reflow group. There were no significant differences in the other plaque components between the two groups. This meta-analysis confirmed that high absolute volume of fibrofatty plaque, EEM-CSA, plaque area, and coronary artery remodeling index, and a decreased percentage of fibrous plaque as detected by IVUS in culprit lesions, are linked with the development of the no-reflow phenomenon after PCI.
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