Plaque erosion versus rupture characterization by optical frequency domain imaging before and after coronary stenting following successful fibrinolysis for ST-segment elevation myocardial infarction

Heart Vessels. 2019 Mar;34(3):401-409. doi: 10.1007/s00380-018-1258-6. Epub 2018 Sep 6.


Intracoronary thrombus burden affects the quality of myocardial reperfusion in the setting of ST-elevation myocardial infarction (STEMI). We aimed to study the characteristics of the plaque and thrombus assessed by intracoronary optical frequency domain imaging (OFDI) according to the presence of plaque rupture or erosion in STEMI patients treated with successful fibrinolysis. Pre-stenting thrombus and post-stenting atherothrombotic burden were compared between plaque rupture and erosion. Twenty-seven consecutive patients were included: 17 (63%) had OFDI-plaque rupture and 10 (37%) had OFDI-erosion. Thrombus volume and burden were significantly higher in case of rupture compared to erosion at baseline (13.4 ± 18.4 vs 2.8 ± 2.3 mm3; p = 0.03 and 33.8 ± 17.5 vs 17.5 ± 9.9%; p = 0.007, respectively). In the rupture group, the core of the thrombus consisted dominantly of red thrombus evenly distributed along the entire culprit plaque. In the erosion group, it consisted dominantly of white thrombus with a focal distribution near the minimal lumen area zone. After stenting, the atherothrombotic volume, burden and its distribution, as well as angiographic estimators of myocardial reperfusion were similar between groups. Our study showed that pre-PCI thrombus amount, typesetting and distribution are mainly linked to the underlying mechanism of STEMI. After stenting, the atherothrombotic burden and its distribution were similar between the groups.

Keywords: Optical frequency domain imaging; Plaque erosion; Plaque rupture; ST-elevation myocardial infarction; Thrombus.

MeSH terms

  • Aged
  • Coronary Angiography
  • Coronary Restenosis / diagnosis*
  • Coronary Restenosis / etiology
  • Coronary Restenosis / surgery
  • Coronary Vessels / diagnostic imaging*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention / methods*
  • Plaque, Atherosclerotic / diagnosis*
  • Plaque, Atherosclerotic / etiology
  • Plaque, Atherosclerotic / surgery
  • Prospective Studies
  • Rupture, Spontaneous
  • ST Elevation Myocardial Infarction / diagnosis
  • ST Elevation Myocardial Infarction / drug therapy*
  • Thrombectomy / methods
  • Thrombolytic Therapy / methods*
  • Tomography, Optical Coherence / methods*