Abstract - The Left Main and Coronary Artery Bifurcation Lesion Summit (CBS)

Abstract

Uncovered Culprit Plaque Ruptures in Patients With ST-Segment Elevation Myocardial Infarction Assessed by Optical Coherence Tomography and Intravascular Ultrasound With iMap
The Future of Biomarker-Guided Therapy for Heart Failure After the Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT) Study
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Sex Differences in Heart Failure With Preserved Ejection Fraction Pathophysiology: A Detailed Invasive Hemodynamic and Echocardiographic Analysis

Clinical Trial

2018 Jun;11(6):859-867.

JOURNAL：JACC Cardiovasc Imaging.

Uncovered Culprit Plaque Ruptures in Patients With ST-Segment Elevation Myocardial Infarction Assessed by Optical Coherence Tomography and Intravascular Ultrasound With iMap

Hougaard M, Hansen HS, Thayssen P et al.

6935

Keywords: OCT; STEMI; plaque rupture

ABSTRACT

OBJECTIVES - This study assessed the incidence and course of healing of uncovered plaque ruptures (PR) following primary percutaneous coronary intervention.

BACKGROUND - The infarct-related occlusion is frequently located at the lesion site with maximum thrombus burden, whereas the culprit PR may be situated more proximally or distally.

METHODS - Uncovered PR in segments adjacent to the stent were identified by optical coherence tomography and intravascular ultrasound using iMap (Boston Scientific, Marlborough, Massachusetts) within 48 h and after 12 months. The percentages of necrotic core, fibrotic tissue, lipid tissue, and calcific tissue were determined.

RESULTS - Eleven uncovered PR were found in 10 of 77 patients (13.0%). Eight of these ruptures (10.4%) were identified as culprit and were located proximal to the stent. Two patients were treated before follow-up due to recurrent symptoms. After 12 months, 3 PR had healed incompletely without causing symptoms. The lumen area at the PR site was reduced (7.5 mm² [interquartile range (IQR): 4.8 to 9.3 mm²] to 3.6 mm² [IQR: 2.8 to 8.0 mm²]; p = 0.012). Proximal segments with uncovered PR had greater plaque volumes (62.1 mm³ [IQR: 50.2 to 83.6 mm³] vs. 38.7 mm³ [IQR: 29.6 to 47.6 mm³], respectively; p < 0.001), vessel volumes (110.7 mm³ [IQR: 92.3 to 128.1 mm³] vs. 76.0 mm³ [IQR: 63.8 to 100.3 mm³], respectively; p < 0.001), and greater percentages of necrotic core (34.0% [IQR: 29.0% to 44.5%] vs. 20.5% (IQR: 10.0% to 29.0%]; p < 0.001). Conversely, percentages of fibrotic tissue were lower (44.0% [IQR: 32.0% to 47.0%] vs. 56.0% [IQR: 46.0% to 66.0%]; p = 0.001), whereas no differences were found for lipid tissue and calcific tissue.

CONCLUSIONS - Uncovered culprit ruptures detected by optical coherence tomography were common following primary percutaneous coronary intervention and were found to be associated with significant lumen reduction during the healing process.