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Exaggerated luminal loss a few minutes after successful percutaneous transluminal coronary angioplasty in patients with recent myocardial infarction compared with stable angina: An intracoronary ultrasound study

1997; Wiley; Volume: 41; Issue: 1 Linguagem: Inglês

10.1002/(sici)1097-0304(199705)41

1097-0304

Tsung‐Ming Lee, Ching-Chi Chu, Yih-Ming Hsu, Ming-Fong Chen, Chiau‐Suong Liau, Yuan‐Teh Lee,

Ultrasound and Hyperthermia Applications

This study investigates the mechanisms of exaggerated acute luminal loss after successful coronary angioplasty in patients with recent myocardial infarction compared with stable angina by angiography and intracoronary ultrasound (ICUS). We studied 15 consecutive patients (group 1) who, after a successful thrombolysis for myocardial infarction, underwent delayed (8 ± 2 days after the myocardial infarction) successful balloon coronary angioplasty. Group 1 patients were individually matched with 15 stable angina patients (group 2). The percentage of stenosis and acute luminal loss were measured by quantitative coronary analysis. The ultrasound characteristics of lumen pathology were described as soft, hard, calcified, eccentric, concentric, thrombotic, and dissection lesions. Matching by stenosis location, reference diameter, sex, and age resulted in 2 comparable groups of 15 lesions with identical baseline characteristics. Immediately after percutaneous transluminal coronary angioplasty (PTCA), the minimal luminal diameter increased from 0.5 ± 0.3 mm to 2.4 ± 0.3 mm and from 0.5 ± 0.2 mm to 2.4 ± 0.3 mm in groups 1 and 2, respectively. Similar balloon sizes were used in both groups. The acute luminal loss (the difference between the maximal dilated balloon diameter and the minimal luminal diameter) immediately after PTCA was 0.4 ± 0.2 mm and 0.3 ± 0.3 mm (14 ± 8% and 10 ± 11% of balloon size) (P = not significant [NS]) in groups 1 and 2, respectively. After ICUS (mean 24 min after the last balloon deflation), the acute luminal loss was 0.9 ± 0.3 mm and 0.5 ± 0.4 mm (29 ± 11% and 17 ± 8% of balloon size) (P = 0.01) in groups 1 and 2, respectively. There was a significantly higher prevalence of intracoronary thrombus formation as detected by ICUS in group 1 compared with group 2 (80% vs. 20%; P < 0.001). In matched groups of successfully treated coronary angioplasty, patients with recent myocardial infarction had a similar magnitude of acute gained luminal loss immediately after the procedure. However, an exaggerated luminal loss a few minutes after the last balloon deflation in patients with recent myocardial infarction was noted because of mural thrombus formation compared with patients with stable angina. Cathet. Cardiovasc. Diagn. 41:32–39, 1997. © 1997 Wiley-Liss, Inc.