CBS - The 17th Left Main & Coronary Bifurcation Summit, CBS2025

血管内超声指导

Usefulness of intravascular ultrasound guidance in percutaneous coronary intervention with second-generation drug-eluting stents for chronic total occlusions (from the Multicenter Korean-Chronic Total Occlusion Registry) A Combined Optical Coherence Tomography and Intravascular Ultrasound Study on Plaque Rupture, Plaque Erosion, and Calcified Nodule in Patients With ST-Segment Elevation Myocardial Infarction: Incidence, Morphologic Characteristics, and Outcomes After Percutaneous Coronary Intervention Impact of Positive and Negative Lesion Site Remodeling on Clinical Outcomes : Insights From PROSPECT Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4,314-patient registry Intravascular Ultrasound Guidance Is Associated With Better Outcome in Patients Undergoing Unprotected Left Main Coronary Artery Stenting Compared With Angiography Guidance Alone American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents Impact of final stent dimensions on long-term results following sirolimus-eluting stent implantation: serial intravascular ultrasound analysis from the sirius trial Utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention for type C lesions

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Original ResearchVolume 72, Issue 16, October 2018

JOURNAL：J Am Coll Cardiol. Article Link

High Coronary Shear Stress in Patients With Coronary Artery Disease Predicts Myocardial Infarction

AKumar, EW Thompson, A Lefieux et al. Keywords: fractional flow reserve; high wall shear stress; proximal segment; stable coronary artery disease; vessel-related myocardial infarction

ABSTRACT

BACKGROUND - Coronary lesions with low fractional flow reserve (FFR) that are treated medically are associated with higher revascularization rates. High wall shear stress (WSS) has been linked with increased plaque vulnerability.

OBJECTIVES - This study investigated the prognostic value of WSS measured in the proximal segments of lesions (WSS_prox) to predict myocardial infarction (MI) in patients with stable coronary artery disease (CAD) and hemodynamically significant lesions. The authors hypothesized that in patients with low FFR and stable CAD, higher WSSprox would predict MI.

METHODS - Among 441 patients in the FAME II (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation II) trial with FFR ≤0.80 who were randomized to medical therapy alone, 34 (8%) had subsequent MI within 3 years. Patients with vessel-related MI and adequate angiograms for 3-dimensional reconstruction (n = 29) were propensity matched to a control group with no MI (n = 29) by using demographic and clinical variables. Coronary lesions were divided into proximal, middle, and distal, along with 5-mm upstream and downstream segments. WSS was calculated for each segment.

RESULTS - Median age was 62 years, and 46 (79%) were male. In the marginal Cox model, whereas lower FFR showed a trend (hazard ratio: 0.084; p = 0.064), higher WSS_prox(hazard ratio: 1.234; p = 0.002, C-index = 0.65) predicted MI. Adding WSS_proxto FFR resulted in a significant increase in global chi-square for predicting MI (p = 0.045), a net reclassification improvement of 0.69 (p = 0.005), and an integrated discrimination index of 0.11 (p = 0.010).

CONCLUSIONS - In patients with stable CAD and hemodynamically significant lesions, higher WSS in the proximal segments of atherosclerotic lesions is predictive of MI and has incremental prognostic value over FFR.

Abstract

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High Coronary Shear Stress in Patients With Coronary Artery Disease Predicts Myocardial Infarction

ABSTRACT