Jong Hyun Yoo

Different impact of mitral regurgitation on clinical outcomes according to timing of percutaneous coronary intervention in patients with non-ST segment elevation myocardial infarction

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Relation between poststenting peristent plaque components and late stent malapposition after drug-eluting stent implantation: Virtual histology-intravascular ultrasound analysis

BACKGROUND Impact of plaque composition on late stent malapposition (LSM) after drug-eluting stent (DES) implantation has not been evaluated. METHODS We evaluated the relation between plaque components at poststenting peristent area (between external elastic membrane and stent areas) and LSM after DES implantation in 266 patients (314 native lesions; paclitaxel-eluting stent in 205 lesions, sirolimus-eluting stent in 66 lesions, zotarolimus-eluting stent in 32 lesions and everolimus-eluting stent in 11 lesions) in whom virtual-histology intravascular ultrasound was performed at index (poststenting) and follow-up (mean: 11.7 ± 4.8 months). RESULTS LSM occurred in 24 patients with 30 lesions (9.6%) and there were no significant differences in the incidences of LSM among 4 DES groups [21/205 (10.2%) in paclitaxel-eluting stent, 6/66 (9.1%) in sirolimus-eluting stent, 2/32 (6.3%) in zotarolimus-eluting stent and 1/11 (9.1%) in everolimus-eluting stent, p=0.5)]. Patients with LSM were presented with more acute myocardial infarction (50% vs. 28%, p=0.026) and were more diabetics (50% vs. 30%, p=0.030) compared with those without LSM. Lesions with LSM had more poststenting peristent %necrotic core (NC) volume compared with those without LSM (25.8 ± 11.1% vs. 21.0 ± 5.7%, p<0.001). Independent predictors of LSM were poststenting peristent %NC volume [odds ratio (OR); 1.216, 95% CI; 1.053-1.405, p=0.008], acute myocardial infarction (OR; 2.897, 95% CI; 1.675-4.118, p=0.029), and diabetes mellitus (OR; 2.413, 95% CI; 1.543-3.996, p=0.038). CONCLUSIONS Poststenting peristent NC component especially in patients with acute myocardial infarction and in those with diabetes mellitus is associated with the development of LSM after DES implantation.

TCT-525 Reduction of Apolipoprotein B/A-I Ratio During Follow-Up Predicts Lower Adverse Event Rate at One Year After Percutaneous Coronary Intervention

Background: It is known that apolipoprotein B/apolipoprotein A-I ratio (ApoB/A-I ratio) could be a risk factor for CAD. Moreover, there are growing evidences that ApoB/A-I can serve as an indicator of coronary plaque regression. However, there is lack of studies that showed causal relationship between plaque regression and clinical outcomes. The aim of this study was to assess the influence of the reduction of ApoB/A-I ratio, the surrogate of plaque regression, on the outcomes after percutaneous coronary intervention (PCI) in patients acute myocardial infarction (AMI). Methods: Between November 2005 to September 2007, we measured serum Lp(a), ApoB and ApoA-I level on admission and six-month follow-up in 1,014 consecutive AMI patients (63.7 12.4 years, 723 men). We divided patients into two groups according to ApoB/A-I ratio reduction (PR Group [plaque regression group]: ApoB/A-I ratio on admission six-month follow-up, non-PR Group [non-plaque regression group]: ApoB/A-I ratio on admission six-month follow-up). Results: There were more men in PR Group (78.0% vs. 65.2%, p 0.188) but, no significant differences in age between groups. Particularly, non-PR group showed better left ventricular ejection fraction than PR group (56.2 11.1 vs. 57.3 14.3 %, p 0.003). There was a trend toward more TIMI 0 flows in PR Group (66.1% vs. 55.5%, p 0.057), while more TIMI 3 flows were observed (26.3% vs. 40.3%, p 0.018) in non-PR Group. CK (1541.