Pre-infarction angina and culprit lesion morphologies in patients with a first ST-segment elevation acute myocardial infarction: insights from in vivo optical coherence tomography.

Abstract

AIMS:

This study aimed to evaluate the relationship between pre-infarction angina (PIA) and in vivo culprit lesion characteristics as assessed by intravascular optical coherence tomography (OCT) in patients with a first ST-segment elevation myocardial infarction (STEMI).

METHODS AND RESULTS:

A total of 305 consecutive patients with a first STEMI who underwent OCT imaging of culprit lesions during primary percutaneous coronary intervention (PCI) were prospectively enrolled. OCT findings of the culprit plaque were compared between patients with (n=206) and without PIA (n=99). Patients with PIA showed lower rates of thin-cap fibroatheroma (TCFA) (62.6% vs. 80.8%, p=0.001) and plaque rupture (56.8% vs. 72.7%, p=0.007), smaller maximum ruptured cavity areas (1.10±1.04 mm2 vs. 1.53±1.20 mm2, p=0.002), and more severe residual luminal narrowing (p=0.015) with a higher incidence of white residual thrombus (68.4% vs. 50.0%, p=0.003) at the culprit lesions than patients without PIA. No significant differences in clinical outcomes were observed at the one-year follow-up.

CONCLUSIONS:

In patients with a first STEMI, PIA was significantly associated with a lower incidence of TCFA and plaque rupture, a smaller ruptured cavity area, more white residual thrombi, and more severe lumen stenosis at the culprit lesions.

• Authors: Rong Sun, Sining Hu, Giulio Guagliumi, Haibo Jia, Jinwei Tian, Lulu Li, Shaotao Zhang, Yini Wang, Shaosong Zhang, Jingbo Hou, Bo Yu
• Journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (EuroIntervention) Vol. 14 Issue 17 Pg. 1768-1775 (Apr 20 2019) ISSN: 1969-6213 [Electronic] France
• PMID: 30277462 (Publication Type: Journal Article)

Topics

• Coronary Angiography
• Humans
• Infarction
• Myocardial Infarction
• Percutaneous Coronary Intervention
• Plaque, Atherosclerotic
• ST Elevation Myocardial Infarction
• Tomography, Optical Coherence