The Influence of Coronary Plaque Morphology Assessed by Optical Coherence Tomography on Final Microvascular Function After Stenting in Patients With ST-elevation Myocardial Infarction

Coron Artery Dis. 2017 May;28(3):198-208. doi: 10.1097/MCA.0000000000000458.

Abstract

Objectives: The index of microcirculatory resistance (IMR) provides a reproducible assessment of the status of coronary microvasculature in patients with ST-elevation myocardial infarction (STEMI). Frequency-domain optical coherence tomography (FD-OCT) enables detailed assessment of the morphology of coronary plaque.We sought to determine the influence of the initial culprit coronary plaque anatomy within the infarct-related artery on IMR after stenting in STEMI.

Patients and methods: In 25 STEMI patients IMR was measured immediately before and after stent implantation. FD-OCT imaging was performed at the same time points and atherothrombotic volume (ATV) before stenting, prolapsed+floating ATV after stenting and ΔATV was measured using three different strategies.

Results: There were no relationships between preprocedural IMR and FD-OCT parameters. Prestenting IMR was related only to pain to wire time (P: 0.02). Irrespective of the method adopted, the final IMR was related to prestenting ATV (ρ: 0.44, P: 0.03 for method I, ρ: 0.48, P: 0.02 for method II and ρ: 0.30, P: 0.06 for method III) and ΔATV (ρ: 0.41, P: 0.04 for method II and ρ: 0.44, P: 0.03 for method III).

Conclusion: IMR measured before stenting is independent of the appearances of the culprit coronary plaque within the infarct-related artery. IMR after stenting, and more importantly, the change in IMR after stenting, reflect the degree of distal embolization during stent implantation.

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / adverse effects
  • Angioplasty, Balloon, Coronary / instrumentation*
  • Cardiac Catheterization
  • Coronary Angiography
  • Coronary Circulation*
  • Coronary Vessels / diagnostic imaging*
  • Coronary Vessels / pathology
  • Coronary Vessels / physiopathology
  • Electrocardiography
  • Female
  • Humans
  • Male
  • Microcirculation*
  • Middle Aged
  • Plaque, Atherosclerotic*
  • Predictive Value of Tests
  • Prospective Studies
  • ST Elevation Myocardial Infarction / diagnostic imaging
  • ST Elevation Myocardial Infarction / pathology
  • ST Elevation Myocardial Infarction / physiopathology
  • ST Elevation Myocardial Infarction / therapy*
  • Stents*
  • Time Factors
  • Tomography, Optical Coherence*
  • Treatment Outcome
  • Vascular Resistance