Target lesion thin-cap fibroatheroma defined by virtual histology intravascular ultrasound affects microvascular injury during percutaneous coronary intervention in patients with angina pectoris

Abstract

Background: Several reports suggest that virtual histology intravascular ultrasound (VH-IVUS) assessment could predict microvascular damage during percutaneous coronary intervention (PCI). A novel index of micro-circulatory resistance (IMR) has been developed as a reproducible and less hemodynamic-dependent index. The purpose of this study was to investigate the relationship between thin-cap fbroatheroma (TCFA) defned by VH-IVUS and a change in the IMR during PCI in patients with angina pectoris (AP).&Methods and Results: The study investigated 30 lesions from 28 AP patients. VH-IVUS imaging was performed before PCI. TCFA was defned as the presence of confuent necrotic core (>10%) without detectable overlying fbrous cap segment. Patients were divided into 2 groups according to the presence of TCFA. Using a pressure guidewire, IMR were measured before and after PCI. After successful PCI, patients were prospectively followed up clinically. TCFA was detected in 9 lesions (30%). IMR tended to improve after PCI in the non-TCFA group, but tended to worsen in the TCFA group. AIMR (=IMR after PCI-IMR before PCI) was signifcantly higher in the TCFA group compared with the non-TCFA group (13.2±29.9 vs -4.4±16.0, P=0.04). During follow-up (mean 20 months), survival free of major adverse cardiac events was signifcantly less in the TCFA group than in the non-TCFA group.&Conclusions: Target lesion TCFA may be related to both microvascular injury and the long-term clinical outcome after successful PCI in patients with AP.