Uncovered Culprit Plaque Ruptures in Patients With ST-Segment Elevation Myocardial Infarction Assessed by Optical Coherence Tomography and Intravascular Ultrasound With iMap.
JACC Cardiovasc Imaging
; 11(6): 859-867, 2018 06.
Article
em En
| MEDLINE
| ID: mdl-28734913
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.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
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Interpretação de Imagem Assistida por Computador
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Ultrassonografia de Intervenção
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Vasos Coronários
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Tomografia de Coerência Óptica
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Placa Aterosclerótica
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Infarto do Miocárdio com Supradesnível do Segmento ST
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article