Laser Vaporization of Intracoronary Thrombus and Identifying Plaque Morphology in ST-Segment Elevation Myocardial Infarction as Assessed by Optical Coherence Tomography

Objectives. We evaluated the thrombus-vaporizing effect of excimer laser coronary angioplasty (ELCA) in patients with ST-segment elevation myocardial infarction (STEMI) by optical coherence tomography (OCT). Background. Larger intracoronary thrombus elevates the risk of interventional treatment and mortality in patients with STEMI. Methods. A total of 92 patients with STEMI who presented within 24 hours from the onset and underwent ELCA following manual aspiration thrombectomy (MT) were analyzed. Results. The mean baseline thrombolysis in myocardial infarction flow grade was 0.4 ± 0.6, which subsequently improved to 2.3 ± 0.7 after MT ( p < 0.0001 ) and 2.7 ± 0.5 after ELCA ( p = 0.0001 ). The median residual thrombus volume after MT was 65.7 mm3, which significantly reduced to 47.5 mm3 after ELCA ( p < 0.0001 ). Plaque rupture was identified by OCT in only 22 cases (23.9%) after MT, but was distinguishable in 36 additional cases after ELCA (total: 58 cases; 63.0%). Ruptured lesions contained a higher proportion of red thrombus than nonruptured lesions (75.9% vs. 43.3%, p = 0.001 ). Significantly larger thrombus burden after MT (69.6 mm3 vs. 56.3 mm3, p < 0.05 ) and greater thrombus reduction by ELCA (21.2 mm3 vs. 11.8 mm3, p < 0.01 ) were observed in ruptured lesions than nonruptured lesions. Conclusions. ELCA effectively vaporized intracoronary thrombus in patients with STEMI even after MT. Lesions with plaque rupture contained larger thrombus burden that was frequently characterized by red thrombus and more effectively reduced by ELCA.

Download Full-text

Prevalence, Features, and Prognosis of Artery‐to‐Artery Embolic ST‐Segment–Elevation Myocardial Infarction: An Optical Coherence Tomography Study

Journal of the American Heart Association ◽

10.1161/jaha.120.017661 ◽

2020 ◽

Vol 9 (24) ◽

Author(s):

Masahiro Takahata ◽

Yasushi Ino ◽

Takashi Kubo ◽

Takashi Tanimoto ◽

Akira Taruya ◽

...

Keyword(s):

Myocardial Infarction ◽

Optical Coherence Tomography ◽

Plaque Rupture ◽

Optical Coherence ◽

Lumen Area ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Plaque Erosion ◽

St Segment ◽

Rupture Site

Background The major underlying mechanisms contributing to acute coronary syndrome are plaque rupture, plaque erosion, and calcified nodule. Artery‐to‐artery embolic myocardial infarction (AAEMI) was defined as ST‐segment–elevation myocardial infarction caused by migrating thrombus formed at the proximal ruptured plaque. The aim of this study was to investigate the prevalence and clinical features of AAEMI by using optical coherence tomography. Methods and Results This study retrospectively enrolled 297 patients with ST‐segment–elevation myocardial infarction who underwent optical coherence tomography before percutaneous coronary intervention. Patients were divided into 4 groups consisting of plaque rupture, plaque erosion, calcified nodule, and AAEMI according to optical coherence tomography findings. The prevalence of AAEMI was 3.4%. The culprit vessel in 60% of patients with AAEMI was right coronary artery. Minimum lumen area at the culprit site was larger in AAEMI compared with plaque rupture, plaque erosion, and calcified nodule (4.0 mm 2 [interquartile range (IQR), 2.2–4.9] versus 1.0 mm 2 [IQR, 0.8–1.3] versus 1.0 mm 2 [IQR, 0.8–1.2] versus 1.1 mm 2 [IQR, 0.7–1.6], P <0.001). Lumen area at the rupture site was larger in patients with AAEMI compared with patients with plaque rupture (4.4 mm 2 [IQR, 2.5–6.7] versus 1.5 mm 2 [IQR, 1.0–2.4], P <0.001). In patients with AAEMI, the median minimum lumen area at the occlusion site was 1.2 mm 2 (IQR, 1.0–2.1), 40% of them had nonstent strategy, and the 3‐year major adverse cardiac event rate was 0%. Conclusions AAEMI is a rare cause for ST‐segment–elevation myocardial infarction and has unique morphological features of plaque including larger lumen area at rupture site and smaller lumen area at the occlusion site.

Download Full-text

A Combined Optical Coherence Tomography and Intravascular Ultrasound Study on Plaque Rupture, Plaque Erosion, and Calcified Nodule in Patients With ST-Segment Elevation Myocardial Infarction

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2015.02.026 ◽

2015 ◽

Vol 8 (9) ◽

pp. 1166-1176 ◽

Cited By ~ 107

Author(s):

Takumi Higuma ◽

Tsunenari Soeda ◽

Naoki Abe ◽

Masahiro Yamada ◽

Hiroaki Yokoyama ◽

...

Keyword(s):

Myocardial Infarction ◽

Optical Coherence Tomography ◽

Intravascular Ultrasound ◽

Plaque Rupture ◽

Optical Coherence ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Plaque Erosion ◽

Ultrasound Study ◽

St Segment

Download Full-text

Association between pre-infarction angina and culprit-lesion morphology in patients with ST-segment elevation myocardial infarction: an optical coherence tomography study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2460 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Wang ◽

Z Sheng ◽

J Li ◽

Y Tan ◽

P Zhou ◽

...

Keyword(s):

Myocardial Infarction ◽

Optical Coherence Tomography ◽

Plaque Rupture ◽

Funding Source ◽

Optical Coherence ◽

Culprit Lesion ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Lesion Morphology

Abstract Background Previous studies reported the cardiac protection effect of pre-infarction angina (PIA) in patients with acute myocardial infarction (AMI). However, the association between PIA and culprit plaques characteristics in AMI patients through optical coherence tomography (OCT)assessment remains unclear. Purpose We sought to identify culprit-plaque morphology associated with PIA in patients with ST-segment elevation myocardial infarction (STEMI) using OCT. Methods A total of 279 STEMI patients who underwent intravascular OCT of culprit-lesion were included. Baseline clinical data and culprit-plaque characteristics were compared between the PIA group the non-PIA group. Results Patients with PIA represented 54.8% of the study population (153 patients). No differences were observed in clinical and angiographic data between two groups, except STEMI onset with exertion was significantly less common in PIA group (24.2% versus 40.5%, P=0.004). Patients with PIA exhibited a significantly lower incidence of plaque rupture (40.5% versus 61.9%, P<0.001) and lipid-rich plaques (48.4% versus 69.0%, P=0.001). The thin-cap fibroatheroma (TCFA) prevalence was lower in PIA group, presenting a thicker fibrous cap thickness, although statistically significant differences were not observed (20.3% versus 30.2%, P=0.070; 129.1±92.0μm versus 111.4±78.1μm, P=0.088; respectively). Multivariate logistic regression analysis indicated that PIA was an independent negative predictor for plaque rupture (odds ratio: 0.44, 95% confidence interval: 0.268–0.725, P=0.001). Conclusion STEMI patients with PIA showed a significantly lower prevalence of plaque rupture and lipid-rich plaques in culprit-lesion than non-PIA group, implying different mechanisms of STEMI attack. Flow chart + Bar graphs of OCT findings Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Association between pre-infarction angina and culprit-lesion morphology in patients with ST-segment elevation myocardial infarction: An optical coherence tomography study

Download Full-text