The decrease of plaque volume during percutaneous coronary intervention has a negative impact on coronary flow in acute myocardial infarction

OBJECTIVES The aim of this study was to evaluate how decreased plaque volume during percutaneous coronary intervention (PCI) affects coronary flow in patients with acute myocardial infarction (AMI). BACKGROUND Coronary flow after reperfusion therapy is a major determinant of clinical outcomes in patients with AMI. However, little is still known about the changes in coronary flow that appear after PCI in response to the decreased plaque during the procedure. METHODS The study group comprised 60 patients with AMI who underwent preand post-PCI intravascular ultrasound (IVUS). Qualitative and quantitative analyses were performed on all IVUS procedures. External elastic membrane volume (EEMV), lumen volume (LV), and plaque volume (PV) were measured every 1.0 mm to include the lesion and reference segments 3.0 mm proximal and distal to the lesion. The difference between preand post-PCI PV was defined as the index of the decrease in plaque volume ( PV). The corrected TIMI frame count (CTFC) was used to evaluate coronary flow after PCI. RESULTS Plaque volume was decreased at post-PCI IVUS in all 60 patients. Inadequate reflow (CTFC 40) was observed in 13 patients (21.7%). The decrease in PV was significantly larger in patients with inadequate reflow than in those with reflow (49.4 18.9 vs. 31.7 15.5 mm, p 0.0010). Also, PV was significantly correlated with CTFC after PCI (r 0.415, p 0.0012). CONCLUSIONS The decrease in PV during PCI has a negative impact on coronary flow after PCI in patients with AMI. Embolization induced by PCI may occur in all patients with AMI. (J Am Coll Cardiol 2004;44:300–4) © 2004 by the American College of Cardiology Foundation