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￭ ♣ S-177 ￭
Impact of Tissue Prolapse after Stent Implantation on Clinical Outcomes in Patients with Acute Myocardial Infarction
전남대학교병원 순환기내과
*홍영준, 정명호, 최윤하, 송진아, 김동한, 이기홍, 쿠쉬드 아메드, 푸토시 야마나까, 이민구, 박근호, 심두선, 윤남식, 윤현주, 김계훈, 박형욱, 김주한, 안영근, 조정관, 박종춘, 강정채
BACKGROUND: The impact of tissue prolapse (TP) on clinical outcomes after stent implantation is still not well known. OBJECTIVES: We used intravascular ultrasound (IVUS) to evaluate the association of TP with short- and long-term clinical outcomes after stent implantation in 418 acute myocardial infarction (AMI) patients (155 ST segment elevation and 263 non-ST segment elevation MI). METHODS: TP was defined as tissue extrusion through the stent strut at post-stenting. We evaluated the incidences of stent thrombosis, no-reflow, and long-term clinical outcomes. RESULTS: After stenting, TP was detected in 34% without difference according to the stent types. Acute and subacute stent thrombosis occurred more frequently in patients with TP compared with those without TP (3.5% vs. 0.7%, p=0.035, and 4.2% vs. 0.7%, p=0.013, respectively). However, no significant difference was observed in the incidence of late stent thrombosis between both groups. No-reflow was developed more frequently in patients with TP compared with those without TP (25.4% vs. 9.8%, p<0.001). Creatine kinase-MB (+9.0±25.2 U/l vs. -4.2±41.6 U/l, p=0.001) and cardiac specific troponin-I (+10.0±43.5 ng/ml vs. -1.2±35.6 ng/ml, p=0.005) were elevated more significantly after stenting in patients with TP compared with those without TP. There were no significant differences in the incidences of cardiac death, MI, and target vessel revascularization at 1-year. Multivariate analysis showed that TP was the independent predictor of composite of acute and subacute stent thrombosis [odds ratio (OR)=4.211; 95% CI 1.198-14.805, p=0.025] and composite of acute stent thrombosis and no-reflow (OR=2.551; 95%
CI 1.315-4.952, p=0.006). CONCLUSIONS: TP was associated with short-term complications (acute and subacute thrombosis and no-reflow phenomenon), however it was not affect long-term clinical outcomes after stent implantation in patients with AMI.
￭ ♣ S-178 ￭
Relation between Microalbuminuria and Vulnerable Plaque Components in Patients with Acute Coronary Syndrome and with Diabetes Mellitus
전남대학교병원 순환기내과
*홍영준, 정명호, 최윤하, 송진아, 김동한, 이기홍, 쿠쉬드 아메드, 푸토시 야마나까, 이민구, 박근호, 심두선, 윤남식, 윤현주, 김계훈, 박형욱, 김주한, 안영근, 조정관, 박종춘, 강정채
Background: We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relation between microalbuminuria and plaque components in 920 patients. Methods: Patients with albumin levels <30 mg/g of creatinine were defined as having normoalbuminuria (n=824), those with albumin levels of 30 to 300 mg/g as having microalbuminuria (n=96). Results: Microalbuminuria group was presented with more acute coronary syndrome (ACS) (72% vs. 61%, p=0.018) and was more diabetics (53% vs. 26%, p<0.001). In ACS patients, %necrotic core (NC) volume was significantly greater in microalbuminuria group compared with normoalbuminuria group (19±10% vs. 15±9%, p=0.019), but not in patients with stable angina. In ACS patients, thin-cap fibroatheroma (TCFA) was observed more frequently in microalbumiuria group (36% vs.
18%, p=0.008), and microalbuminuria was the independent predictor of TCFA (Odds ratio=1.106; 95% CI 1.025-1.144, p=0.018). In diabetic patients, %NC volume was significantly greater in microalbuminuria group compared with normoalbuminuria group (20±9% vs. 16±10%, p=0.017), but not in non-diabetic patients. In diabetic patients, TCFA was observed more frequently in microalbumiuria group (38% vs. 17%, p=0.002) and microalbuminuria was the independent predictor of TCFA (Odds ratio=1.120; 95% CI 1.038-1.204, p=0.012). Conclusions:
Microalbuminuria was associated with more vulnerable plaque components in ACS and diabetic patients. More intensive medical therapy is needed to stabilize the vulnerable plaque if microabluminuria is observed in diabetic ACS patients.
