The Effect Of Coronary Plaque Vulnerability Assessed By VH-IVUS On Myocardial Perfusion After PCI

Objective:To explore the possible factors of vulnerable plaque in coronary artery and the influence of vulnerable plaque assessed by VH-IVUS on blood perfusion and myocardial cell injury after PCI.Methods:A retrospective analysis was performed in 83 patients who received VH-IVUS-assisted PCI treatment in Hunan Provincial people’s hospital from April 2017 to January 2019.According to the plaque vulnerability assessed by VH-IVUS,they were divided into non-vulnerable plaque group and vulnerable plaque group.The general clinical data between the two groups were analyzed,and the plaque characteristics were assessed by VH-IVUS.The factors affecting the plaque stability and the changes of myocardial perfusion and myocardial cell injury after PCI were discussed.Results:Compared with the non-vulnerable plaque group,the level of homocysteine in the vulnerable plaque group increased(15.7±5.31 vs 18.2±5.34,p<0.05).Compared with the vulnerable plaque group before PCI,the TIMI frame(21.9±1.36 vs 24.3±1.73),TIMI frame(23.6±2.26 vs 25.9±2.24)and TIMI frame(23.9±4.45 vs 26.3±4.33)of the left anterior descending artery were all increased after PCI(p<0.05).Compared with the non-vulnerable plaque group,the vulnerable plaque group corrected the TIMI frame difference of the left anterior descending branch(1.4±0.74 vs 2.4±1.08),the TIMI frame difference of the left cyclotron branch(1.2±0.48 vs 2.3±1.16),and the TIMI frame difference of the right coronary artery(1.3±0.81 vs 2.4±1.03)were all increased,(p<0.05).Logistic regression analysis showed that homocysteine level [OR(95%CI)(1.886 ~ 4.227),p<0.05] was an independent risk factor for the occurrence of vulnerable plaques.Partial correlation analysis showed that FBG was positively correlated with the percentage of necrotic core tissue area under the control of triglyceride variables [r=0.25,sig(unilateral)=0.034].Absolute value of fibrous adipose tissue area in the non-vulnerable plaque group and vulnerable plaque group [2.55(1.2,3.45)vs 1.4(0.6,2.25)],absolute value of dense calcification tissue area [0.1(0,0.2)vs 0.5(0.3,0.7)],absolute value of necrotic core tissue area [0.5(0.2,0.63)vs 1.3(1,2.05)],percentage of fibrous adipose tissue area [28.60(21.81,43.11)vs 19.23(10.77,24.12)],the percentage of dense calcified tissue area [0.73(0,2.4)vs 6.52(3.02,10.38)] and the percentage of necrotic core tissue area [6.96(4,8.97)vs 16.46(13.21,26.36)] were all increased,(p<0.05).Conclusion:1.Increased homocysteine may increase plaque vulnerability.2.The vulnerable plaque assessed by VH-IVUS is prone to myocardial perfusion dysfunction and myocardial cell injury after PCI.