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. 2001 Apr;85(4):402–406. doi: 10.1136/heart.85.4.402

Lesion characteristics of acute myocardial infarction: an investigation with intravascular ultrasound

D Fukuda 1, T Kawarabayashi 1, A Tanaka 1, Y Nishibori 1, H Taguchi 1, Y Nishida 1, K Shimada 1, J Yoshikawa 1
PMCID: PMC1729694  PMID: 11250964

Abstract

OBJECTIVE—To use intravascular ultrasound (IVUS) to compare plaque morphology in acute myocardial infarction and stable angina pectoris.
DESIGN—Retrospective study.
SETTING—Primary care hospital.
PATIENTS—59 consecutive cases of acute myocardial infarction and 50 consecutive cases of stable angina pectoris.
METHODS—IVUS was used before coronary intervention.
MAIN OUTCOME MEASURES—Plaque morphology (incidence of eccentric plaque, subtle dissections, low echoic thrombus, calcification, echolucent areas, and bright speckled echo material), assessed visually using IVUS.
RESULTS—There were no significant differences in plaque eccentricity or calcification between the two groups, but low echoic thrombus (acute myocardial infarction 15% v stable angina pectoris 0%), subtle dissections (37% v 4%), echolucent areas (31% v 0%), and bright speckled echo material (90% v 0%) were more common in the infarction group than in the stable angina group (p < 0.001 for all). There was a longer time between the onset of symptoms and the IVUS examination in patients with low echoic thrombus than in those without (p < 0.03).
CONCLUSIONS—Low echoic thrombus, subtle dissections, echolucent areas, and bright speckled echo material are morphological characteristics associated with plaque at the time of acute myocardial infarction. These findings correspond pathologically to ruptured plaque.


Keywords: intravascular ultrasound; acute myocardial infarction; plaque morphology

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Figure 1  .

Figure 1  

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Coronary angiography and intravascular ultrasound (IVUS) images—1. The coronary angiography and IVUS images of a patient with acute myocardial infarction in the right coronary artery territory. (A, top left) Coronary angiography shows the right coronary artery with 99% stenosis in the mid-portion. (B, top right) A plain IVUS image of proximal stenosis. This shows bright speckled echo material. (C, bottom left) A plain IVUS image with suspected plaque dissection. (D, bottom right) Negative contrast image of (C). This reveals the plaque dissection at 3 o'clock more clearly than the plain image.

Figure 2  .

Figure 2  

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Coronary angiography and intravascular ultrasound (IVUS) images—2. The coronary angiography and IVUS images of a patient with acute myocardial infarction in left anterior descending coronary artery (LAD) territory. (A, top left) Coronary angiography shows filling defect in the mid-portion of the LAD. (B, top right) IVUS image of low echoic thrombus. In concordance with the angiographic findings, a low echoic mass representing thrombus can be seen at 12 to 2 o'clock. (C, bottom left) IVUS image with subtle dissection at 6 o'clock. (D, bottom right) IVUS image representing echolucent area at 4 to 6 o'clock; a low echoic lesion can be seen in the eccentric plaque.

Figure 3  .

Figure 3  

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Comparison of time from onset of symptoms between cases with and without low echoic thrombus. The time course in cases with low echoic thrombus was significantly longer than in those without low echoic thrombus.

Selected References

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