Optical Coherence Tomography Assessment of Coronary Lesions Associated With Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction

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  • Feng Xue
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Xu Yishuo
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Zeng Ming
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Qin Yuhan
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Weng Ziqian
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Sun Yanli
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Gao Zhanqun
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • He Luping
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Zhao Chen
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Wang Ning
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Zhang Dirui
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Wang Chao
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Wang Yini
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Li Lulu
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Fang Chao
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Dai Jiannan
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Jia Haibo
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
  • Yu Bo
    Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education

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<p>Background: Microvascular reperfusion following percutaneous coronary intervention (PCI) is associated with the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). We investigated how plaque characteristics detected by optical coherence tomography (OCT) in STEMI patients affect the status of the microcirculation during PCI.</p><p>Methods and Results: This retrospective, single-center study was a post hoc analysis basedon the multicenter SALVAGE randomized control trial (NCT03581513) that enrolled 629 STEMI patients, and finally we enrolled 235 patients who underwent PCI and pre-intervention OCT. Microvascular perfusion was evaluated using the Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion frame count (TMPFC). Patients were divided into 3 groups based on the change in TMPFC from before to after PCI: improving TMPFC (n=11; 4.7%), stable TMPFC (n=182; 77.4%), and worsening TMPFC group (n=42; 17.9%). The proportion of patients with a microcirculation dysfunction before reperfusion was 11.9%, which increased significantly by (P=0.079) 8.5% to 20.4% after reperfusion. Compared with plaque characteristics in the stable and worsening TMPFC groups, the improving TMPFC group had fewer thrombi (90.7% and 90.5% vs. 89.4%, respectively; P=0.018), a lower proportion of plaque rupture (66.5% and 66.3% vs. 54.5%, respectively; P=0.029), and a lower proportion of lipid-rich plaques (89.6% and 88.1% vs. 63.6%, respectively; P=0.036).</p><p>Conclusions: PCI may not always achieve complete myocardial reperfusion. Thrombi, plaque rupture, and lipid-rich plaques detected by OCT can indicate microcirculation dysfunction during the reperfusion period.</p>

収録刊行物

  • Circulation Journal

    Circulation Journal 87 (11), 1625-1632, 2023-10-25

    一般社団法人 日本循環器学会

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