Author + information
- Lin Wang,
- Guido Parodi,
- Akiko Maehara,
- Renato Valenti,
- Angela Migliorini,
- Ruben Vergara,
- Nazario Carrabba,
- Gary Mintz and
- David Antoniucci
Comparison of Manual Aspiration with Rheolytic Thrombectomy (SMART) randomized pts with ST–elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) to manual aspiration vs rheolytic thrombectomy.
We used optical coherence tomography (OCT) to evaluate culprit lesion morphology in 80 pts who had primary PCI within 6 hours of symptom onset.
Overall, 73 culprit lesions were evaluable to determine the underlying morphology: (1) 37 lesions with plaque rupture, (2) 23 lesions without rupture, but with a severe stenosis and only a small amount of thrombus and (3) 10 lesions with a large amount of thrombus without rupture. Among the 37 plaque ruptures, 20 contained either a single rupture cavity >180° or multiple ruptures while 17 had a single rupture <180°. Calcified nodules were found in 2 lesions with a moderate amount of thrombus;1 lesion contained both rupture and a calcified nodule. Differences between 37 culprit lesions with a plaque rupture vs 23 severe stenosis without rupture are shown (Table). Rupture pts were younger and more often male. Rupture lesions more often contained a thin cap fibroatheroma (TCFA) in a large artery. Severe stenoses more often had fibrous plaque in the distal reference.
Not all culprit lesions in STEMI pts are ruptured plaques. OCT analysis shows 2 distinct prevalent morphologies: plaque rupture with a large amount of thrombus or severe stenosis with only a small amount of thrombus.
Differences between Rupture Group and Stenosis Group.
|RUPTURE GROUP(n=37)||STENOSIS GROUP(n=23)||p-value|
|Age (yrs)||64 ± 12||70 ± 10||0.041|
|Female||10.8% (4)||43.5% (10)||0.004|
|Body surface area (m2)||1.9 ± 0.2||1.8 ± 0.2||0.005|
|TCFA||54.1% (20)||21.7% (5)||0.014|
|Fibrous plaque in distal reference||16.2% (6)||43.5% (10)||0.002|
|QCA reference diameter (mm)||3.34 ± 0.41||3.13 ± 0.35||0.045|
West, Room 2004
Monday, March 11, 2013, 8:30 a.m.–8:40 a.m.
Session Title: Intravascular Imaging: Focus on OCT
Abstract Category: 38. TCT@ACC–i2: Intravascular Imaging and Physiology
Presentation Number: 2912–5
- 2013 American College of Cardiology Foundation