Coronary Imaging

(Abstract nos. AS-132–AS-144

AS-132

Relationship between Tissue Prolapse and Arterial Healing afterSES Implantation following Cutting Balloon Angioplasty: AnOptical Coherence Tomography Analysis. Kenichi Komukai,Masato Mizukoshi, Hironori Kitabata, Atsushi Tanaka,Takashi Kubo, Shigeho Takarada, Kumiko Hirata, Keizou Kimura,Yasushi Ino, Takashi Tanimoto, Kohei Ishibashi, Kazushi Takemoto,Toshio Imanishi, Takashi Akasaka. Wakayama Medical University,Wakayama, Japan.

Background: Sirolimus-eluting stents (SES) are frequently implantedfollowing cutting balloon angioplasty (CB) for in-stent restenosis (ISR)with large neointimal hyperplasia. Coronary stent deployment is oftenassociated with tissue prolapse, and it can cause such complications asacute occlusion. However, what effect tissue prolapse can have onarterial healing has not been fully elucidated. Optical coherence to-mography (OCT) is a high-resolution imaging modality and allows usto analyze vascular response after stenting in detail. The purpose of thisstudy was to evaluate the relationship between tissue prolapse andarterial healing by OCT.

Methods: We evaluated the degree of tissue prolapse in 31 patientswith stable angina pectoris after stent implantation. The patients weredivided into 2 groups: 1) the CB (�) group—SES implantation fol-lowing CB for the in-stent restenosis group (n � 15); 2) the CB (�)group—SES implantation without CB group (n � 16). We measuredtissue prolapse area and stent cross-sectional area (CSA) by OCT at thesite of maximal tissue prolapse immediately after the procedure andanalyzed stent apposition and neointimal coverage at a 9-month follow-up.

Results: The ratio of tissue prolapse area to stent CSA wassignificantly greater in the CB (�) group than in CB (�) group(0.116 � 0.046 vs 0.067 � 0.018, p � 0.009). However, there wasno significant difference in the ratio of stent CSA to reference lumenCSA between groups: CB (�) group 1.235 � 0.202, CB (�) group1.431 � 0.279. At 9-month follow-up, incomplete stent appositionwas observed more frequently in CB (�) group than in CB (�)group (malapposed struts per lesion 4.76 � 1.08% vs 3.46 � 1.27%,p � 0.034). Furthermore, peristrut ulcer like appearance were seenmore frequently in CB (�) group than in CB (�) group (75.0% vs7.7% of patients, p � 0.001), and thrombus was observed around theperistrut ulcer. The average rate of neointima-uncovered struts in anindividual SES was greater in CB (�) group than in CB (�) group(8.8% vs 4.5%).

Conclusion: Compared with SES implantation without CB, SESimplantation following CB was associated with greater tissue prolapseimmediately after stent implantation and resulted in late stent malap-position, although similar stent expansion was obtained in both groups.Although arterial healing may be delayed after SES implantation withCB, these findings were not associated with stent thrombosis in patientswith antiplatelet therapy.

AS-133Computed Tomography Coronary Angiography in HemodialysisPatients. Teppei Sugaya, Takayoshi Yamaguchi, Jungo Furuya,Yasumi Igarashi, Keiichi Igarashi. Hokkaido Social InsuranceHospital, Sapporo, Japan.

Background: In general, it is said that the evaluation of stenosis bycomputed tomography coronary angiography (CTCA) is difficult inhemodialysis (HD) patients who frequently have calcified lesions. Theaim of this study was to evaluate the clinical usefulness of CTCA inHD patients.

Methods: We consecutively performed 1401 cases of 64-sliceCTCA in 2008. Among them, we analyzed 1309 cases (non-HD: 1229cases; HD: 80 cases), except for cases of motion artifact.

Results: The underlying disease in HD patients was diabetes mel-litus (DM; 51.3 %), chronic glomerulonephritis (CGN; 22.5 %), other(8.9 %), or unclear (17.5 %). We could not evaluate the stenosis forcalcification at 1 or more segments in 135 non-HD patients (11.0 %)and in 31 HD patients (38.8 %). In HD patients, although there was nosignificant difference in the underlying disease or age, there weresignificant differences in duration of HD between evaluable cases andunevaluable cases (total: � 68.8 months vs 123.3 � 93.6 months; DM:49.3 � 43.6 months vs 106.3 � 96.3 months; CGN: 85.2 � 109.5months vs 140.5 � 98.1 months). We could compare CTCA withcoronary angiography in 20 HD patients. If we considered unevaluablelesions for calcification as stenosis, the accuracy of CTCA in HDpatients was 93% in clinically important vessels.

Conclusion: In this study, the degree of the calcification of coro-nary arteries related to the duration of HD significantly. Although thereare several limitation to assessing stenosis in calcified lesion, CTCAmay be useful with HD patients in real clinical practice.

AS-134Comparison of Culprit Lesions of Stable Angina and AcuteCoronary Syndrome with Multidetector Computed Tomography.So Yeon Kim, Myeung Joon Seung, Young Soo Lee, Jin Bae Lee,Jae Kean Ryu, Ji Young Choi, Sung-Gug Chang. Daegu CatholicUniversity Hospital, Daegu, Republic of Korea.

Background: Disruption of coronary artery plaque is the primarycause of acute coronary syndrome (ACS). The vulnerable, rupture-prone plaques are characterized by large lipid cores with thin fibrouscaps, positive remodeling, and small coronary calcium. Recently, mul-tidetector computed tomography (MDCT) has been known to charac-terize the coronary artery plaques. We studied the difference of culpritlesions between ACS and stable angina pectoris (SAP) using multide-tector computed tomography (MDCT)

Methods: Sixty-four-slice MDCT was conducted in 59 patients, 26patients of whom had ACS and 33 SA before percutaneous coronaryintervention (PCI). The culprit coronary lesions were evaluated forsignal intensity (SI) of plaque presenting as Hounsfield units (HU),spotty calcification, outer vessel diameter, and area in culprit andreference lesion. The remodeling index (RI) was defined as the ratio oflesion diameter and mean of proximal and distal reference diameter.

Results: In patients with ACS, culprit coronary lesions had signif-icantly higher RI than patients with SAP (1.14 � 1.19 vs 0.91 � 0.30,p � 0.001). The plaque of culprit coronary lesions in patients with ACSwere less calcified (3.8% vs 36.4%, p � 0.008). The mean SI of plaqueswas significantly lower in ACS patients (38.39 � 22.35HU vs 89.16 �43.45HU, p � 0.000) In addition, more spotty calcification was ob-served in patients with ACS (93.8% vs 23.8%, p � 0.001). Receiveroperator characteristic (ROC) curves showed discrimination betweenSAP and ACS with 53.3 HU of SI (sensitivity of 80.6%, specificity of76.9%, and an area of 0.822), and 1.05 of RI (sensitivity of 73.1%,

The American Journal of Cardiology� APRIL 28–30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster 57B

E-POSTER

ABSTRACTS

Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone)

specificity of 84.8%, and an area of 0.808). When total lesion score wasdefined by summing of all scores as 1 of noncalcified or mixed plaques,there were 1 of spotty calcium, 1 of RI �1.05, and 1 of SI of plaque�53.3. Total lesion score (TLS) was higher in patient with ACS(3.04 � 0.77 vs 1.19 � 1.03, p � 0.000). On multivariate analysis, TLSwas significantly associated with ACS (odds ratio 27.20, p � 0.037).ROC curves showed TLS could significantly differentiate ACS using acutoff value of 2.5 (sensitivity 73.1%, specificity 93.7%, p � 0.000; seeFigure).

Conclusion: In our study, the culprit lesions of ACS had higher RI,lower plaque SI, and more spotty calcification than SAP lesions. TLSmay be helpful to differentiate between ACS and SAP.

AS-135Two-Year Clinical Outcome in Patients with AngiographicallyIntermediate Lesions with Minimum Lumen Area <4 mm2 usingIntravascular Ultrasound in Nonproximal Epicardial CoronaryArtery. Eun Hye Ma, Young Joon Hong, Myung Ho Jeong,Yun Ha Choi, Jum Suk Ko, Min Goo Lee, Keun Ho Park,Doo Sun Sim, Ju Han Kim, Youngkeun Ahn, Jeong Gwan Cho,Jong Chun Park, Jung Chaee Kang. Chonnam National UniversityHospital, Gwangju, Republic of Korea.

Background: The cutoff value of intravascular ultrasound (IVUS)minimum lumen area (MLA) �4 mm2 is currently used for the pre-diction of future clinical events in patients with proximal epicardialcoronary artery disease. We evaluated the 2-year clinical outcome inpatients with angiographically intermediate lesions with IVUS MLA�4 mm2 in nonintervened nonproximal epicardial coronary artery.

Methods: We retrospectively enrolled 55 patients (28 men, 63.2 �9.1 years) with angiographically intermediate lesions (diameter steno-sis 30%–70%) with IVUS MLA �4 mm2 in nonintervened nonproxi-mal epicardial coronary artery with reference lumen diameter between2.25 and 3.0 mm. We evaluated the incidence of 2-year clinical events(cardiac death, nonfatal myocardial infarction, cerebrovascular acci-dents, and target lesion and target vessel revascularizations) aftermedical therapy.

Results: Most of the patients had stable (40%) and unstable anginas(44%). The incidences of hypertension and diabetes mellitus were 58%and 26%, respectively. IVUS MLA was 3.56 � 0.41 mm2, and plaqueburden was 64.1% � 7.0%. During 2-year follow-up, although 3noncardiac deaths (5.5%) and 1 cerebrovascular accident occurred,there were no cardiac deaths and no myocardial infarctions. Targetlesion revascularization was performed in 5 patients (9.1%), and targetvessel revascularization was performed in 6 patients (10.9%). When wecompared clinical, angiographic, and IVUS parameters between pa-tients with and without 2-year follow-up clinical events, there were nodifferences between both groups. By multivariable analysis, only dia-betes mellitus was an independent predictor of 2-year target vesselrevascularization.

Conclusion: Event rates are relatively low with medical therapy anno intervention, and thus the cutoff of IVUS MLA 4 mm2 may not beapplied to patients with angiographically intermediate lesions withIVUS MLA �4 mm2 in nonproximal epicardial coronary arteries.

AS-136Correlation between Body Mass Index and AngiographicFindings of Patients Who Underwent Coronary Angiography atChinese General Hospital and Medical Center from 2000 to2005: A Retrospective Study. Henry (Lim) Chan, Claudine Ong.Chinese General Hospital and Medical Center, Manila, Philippines.

Background: Obesity, considered one of the risk factors of coronaryartery disease (CAD), is reaching in epidemic proportions amongdeveloped countries. Recent studies have focused on an apparent par-adox regarding the relationship between obesity and subsequent car-diovascular (CV) prognosis, known as the “obesity paradox.” Althoughit has been proved that the severity of coronary artery lesions adverselyaffects CV outcome, there are no data correlating obesity with severityof CAD. This study therefore aimed to determine whether a relation-ship (paradoxical or not) exists between obesity and severity of lesionsamong patients who underwent coronary angiography at Chinese Gen-eral Hospital and Medical Center from 2000 to 2005.

Methods: Included in the study were 2165 adult male and femalepatients aged �18 years who satisfied the inclusion and exclusioncriteria. Descriptive statistics were computed for all quantitative vari-ables, and percentages were generated for all qualitative variables.Analysis of variance and chi-square test (dichotomous) were used whenappropriate to compare the differences of patients across the 5-levelbody mass index (BMI) groups with respect to their characteristics.Logistic regression was used to determine the association between BMIand CAD. All conclusions are based on a 95% confidence interval.

Results: The majority of the patients were men (78.8%) and hadobstructive CAD (70.6%). Patients were classified according to theBMI for Asians as underweight (BMI �18.5 kg/m2), normal (18.5 �

BMI �23), overweight (23 � BMI � 25), obese I (25 � BMI �30),and obese II (BMI �30). Comparing across the 5 groups, significantdifferences were observed with respect to sex (p �0.0001), age (p�0.0001), and dyslipidemia (p � 0.0004). Comparing between patientswith obstructive and nonobstructive CAD, significant differences wereobserved with respect to sex (p �0.0001), age (p � 0.0479), diabetesmellitus (p � 0.0003), smoking (p � 0.0002), family history of CAD(p � 0.0336), and previous MI (p �0.0001). To adjust for covariates,the relation between obesity and severity of CAD was examined in amultivariate logistic model. It was shown that there was no statisticalsignificance directly correlating obesity with obstructive CAD.

Conclusion: This study showed that there no significant relation-ship exists between obesity and severity of CAD. This study partlyunravels the obesity paradox on PCI outcome.

AS-137Incidence and Predictors of Asymptomatic Coronary ArteryDisease Detected by Coronary CT Angiography in Type 2Diabetic Patients. Se Hun Kang, Seung-Whan Lee,Seong-Wook Park, Wo Je Lee, Joong Yeol Park, Ki Up Lee,Won-Jang Kim, Jong-Young Lee, Duk-Woo Park, Soo-Jin Kang,Cheol Whan Lee, Jae-Joong Kim, Seung-Jung Park. Asan MedicalCenter, Seoul, Republic of Korea.

Background: There has been controversy regarding the utility ofscreening for asymptomatic coronary artery disease (CAD) in type 2diabetic patients and which screening tests are most useful. The pur-pose of this study was to explore the characteristics of the patients with

58B The American Journal of Cardiology� APRIL 28–30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster

E-POSTER

ABSTRACTS

Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone)