Analysis Of Risk Factors Of Coronary No-reflow/Slow-flow Phenomenon And Vulnerability Of Coronary Atherosclerotic Plaque, And The Predictive Value Of Virtual Histology Intravascular Ultrasound In No-reflow/Slow-flow Phenomenon

OBJECTIVE:No-reflow/slow-flow phenomenon (NF) is a poor prognostic factor in patientsundergoing percutaneous coronary intervention. This study is to investigate therelationship between serum homocysteine(HCY) and no-reflow/slow-flowPhenomenon after percutaneous coronary intervention(PCI)， and discuss themechanism of HCY inducing vulnerable plaque, and investigate the correlationbetween composition of the coronary atherosclerotic plaque detected by gray-scaleintravascular ultrasound(IVUS)and virtual histology intravascularultrasound(VH-IVUS) and no-reflow/slow-flow phenomenon after percutaneouscoronary intervention.METHODS:Among80CHD patients treated with PCI，30with no-reflow/slow-flow phenomenon after PCI (no-reflow/slow-flow group)and50withoutno-reflow/slow-flow phenomenon after PCI (normal reflow group)，body massindex(BMI),history of hypertension，history of smoking, the levels of serum fastingglucose, homocysteine(HCY), triglyceride(TG), total cholesterol(TC)，high densitylipoprotein（HDL）, low density lipoprotein（LDL）were investigated in all groups,IVUS and VH-IVUS was performed in all patients before PCI. According the resultsof IVUS and VH-IVUS all patients divided into vulnerable plaque grou（pn=26）andnormal control group（n=54）.The contrastive analysis and logistic analysis wereconducted.RESULT:The level of HCY was statistically different between no-reflow/slow-flow groupand normal reflow group(P<0.05),but BMI,history of hypertension，history ofsmoking,the levels of serum fasting glucose, TG,TC,HDL LDL had no statisticallydifference between the two groups(P>0.05). The multiple analysis of logisticregression showed that HCY(OR=4.716P<0.01) and LDL(OR=2.154P<0.05) wasthe independent risk factor of no-reflow/slow-flow phenomenon after PCI. Theproportion of necrotic core had statistically difference between the two groups, butthe proportion of fiber, fiber liquid, dense calcium had no statistical differencebetween the two groups. The level of HCY was statistically different betweenvulnerable plaque group and normal control group(P<0.05),but BMI,history ofhypertension， history of smoking, the levels of serum fasting glucose,TG,TC,HDL,LDL had no statistically difference between the two groups(P>0.05).The multiple analysis of logistic regression showed that HCY(OR=1.531P<0.05)and LDL(OR=1.155P<0.05) was the independent risk factor of vulnerability ofcoronary atherosclerotic plaque.CONCLUSION:The level of HCY and LDL is an independent risk factor of no-reflow/slow-flowphenomenon after PCI, also an independent risk factor of vulnerability of coronary atherosclerotic plaque. The proportion of necrotic core detected by VH-IVUS maypredict no-reflow/slow-flow phenomenon after PCI.