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Uncovered Culprit Plaque Ruptures in Patients With ST-Segment Elevation Myocardial Infarction Assessed by Optical Coherence Tomography and Intravascular Ultrasound With iMap.
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2017-07-19 , DOI: 10.1016/j.jcmg.2017.03.019 Mikkel Hougaard 1 , Henrik Steen Hansen 1 , Per Thayssen 1 , Lisbeth Antonsen 1 , Lisette Okkels Jensen 1
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2017-07-19 , DOI: 10.1016/j.jcmg.2017.03.019 Mikkel Hougaard 1 , Henrik Steen Hansen 1 , Per Thayssen 1 , Lisbeth Antonsen 1 , Lisette Okkels Jensen 1
Affiliation
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OBJECTIVES
This study assessed the incidence and course of healing of uncovered plaque ruptures (PR) following primary percutaneous coronary intervention.
BACKGROUND
The infarct-related occlusion is frequently located at the lesion site with maximum thrombus burden, whereas the culprit PR may be situated more proximally or distally.
METHODS
Uncovered PR in segments adjacent to the stent were identified by optical coherence tomography and intravascular ultrasound using iMap (Boston Scientific, Marlborough, Massachusetts) within 48 h and after 12 months. The percentages of necrotic core, fibrotic tissue, lipid tissue, and calcific tissue were determined.
RESULTS
Eleven uncovered PR were found in 10 of 77 patients (13.0%). Eight of these ruptures (10.4%) were identified as culprit and were located proximal to the stent. Two patients were treated before follow-up due to recurrent symptoms. After 12 months, 3 PR had healed incompletely without causing symptoms. The lumen area at the PR site was reduced (7.5 mm2 [interquartile range (IQR): 4.8 to 9.3 mm2] to 3.6 mm2 [IQR: 2.8 to 8.0 mm2]; p = 0.012). Proximal segments with uncovered PR had greater plaque volumes (62.1 mm3 [IQR: 50.2 to 83.6 mm3] vs. 38.7 mm3 [IQR: 29.6 to 47.6 mm3], respectively; p < 0.001), vessel volumes (110.7 mm3 [IQR: 92.3 to 128.1 mm3] vs. 76.0 mm3 [IQR: 63.8 to 100.3 mm3], respectively; p < 0.001), and greater percentages of necrotic core (34.0% [IQR: 29.0% to 44.5%] vs. 20.5% (IQR: 10.0% to 29.0%]; p < 0.001). Conversely, percentages of fibrotic tissue were lower (44.0% [IQR: 32.0% to 47.0%] vs. 56.0% [IQR: 46.0% to 66.0%]; p = 0.001), whereas no differences were found for lipid tissue and calcific tissue.
CONCLUSIONS
Uncovered culprit ruptures detected by optical coherence tomography were common following primary percutaneous coronary intervention and were found to be associated with significant lumen reduction during the healing process.
中文翻译：
通过光学相干断层扫描和iMap进行血管内超声评估，对ST段抬高型心肌梗死患者发现未发现的Culprit斑块破裂。
目的本研究评估了原发性经皮冠状动脉介入治疗后未发现斑块破裂（PR）的发生率和愈合过程。背景技术与梗塞相关的闭塞常常位于具有最大血栓负担的病变部位，而罪魁祸首PR可能位于更近端或远端。方法通过光学相干断层扫描和血管内超声，使用iMap（Boston Scientific，Marlborough，Massachusetts）在48 h内和12个月后鉴定与支架相邻的节段中未发现的PR。确定坏死核心，纤维化组织，脂质组织和钙化组织的百分比。结果77例患者中有10例发现11例未发现PR（13.0％）。这些断裂中的八个（10.4％）被确认为罪魁祸首，位于支架的近端。由于复发症状，在随访之前对两名患者进行了治疗。12个月后，有3例PR完全愈合，没有引起任何症状。PR部位的管腔面积减少了（7.5 mm2 [四分位间距（IQR）：4.8至9.3 mm2]至3.6 mm2 [IQR：2.8至8.0 mm2]； p = 0.012）。未发现PR的近端节段的斑块体积更大（62.1 mm3 [IQR：50.2至83.6 mm3]与38.7 mm3 [IQR：29.6至47.6 mm3]; p <0.001），血管体积（110.7 mm3 [IQR：92.3至32.3] 128.1 mm3]和76.0 mm3 [IQR：63.8至100.3 mm3]； p <0.001）和更大百分比的坏死芯（34.0％[IQR：29.0％至44.5％] vs. 20.5％（IQR：10.0％） ；至29.0％]（p <0.001）；相反，纤维化组织的百分比较低（44.0％[IQR：32.0％至47.0％]与56.0％[IQR：46.0％至66.0％]； p = 0.001），而脂质组织和钙化组织没有差异。结论在初次经皮冠状动脉介入治疗后，通过光学相干断层扫描发现的未发现的元凶破裂是常见的，并且被发现与愈合过程中显着的管腔减少有关。
更新日期：2018-06-05
中文翻译：
通过光学相干断层扫描和iMap进行血管内超声评估，对ST段抬高型心肌梗死患者发现未发现的Culprit斑块破裂。
目的本研究评估了原发性经皮冠状动脉介入治疗后未发现斑块破裂（PR）的发生率和愈合过程。背景技术与梗塞相关的闭塞常常位于具有最大血栓负担的病变部位，而罪魁祸首PR可能位于更近端或远端。方法通过光学相干断层扫描和血管内超声，使用iMap（Boston Scientific，Marlborough，Massachusetts）在48 h内和12个月后鉴定与支架相邻的节段中未发现的PR。确定坏死核心，纤维化组织，脂质组织和钙化组织的百分比。结果77例患者中有10例发现11例未发现PR（13.0％）。这些断裂中的八个（10.4％）被确认为罪魁祸首，位于支架的近端。由于复发症状，在随访之前对两名患者进行了治疗。12个月后，有3例PR完全愈合，没有引起任何症状。PR部位的管腔面积减少了（7.5 mm2 [四分位间距（IQR）：4.8至9.3 mm2]至3.6 mm2 [IQR：2.8至8.0 mm2]； p = 0.012）。未发现PR的近端节段的斑块体积更大（62.1 mm3 [IQR：50.2至83.6 mm3]与38.7 mm3 [IQR：29.6至47.6 mm3]; p <0.001），血管体积（110.7 mm3 [IQR：92.3至32.3] 128.1 mm3]和76.0 mm3 [IQR：63.8至100.3 mm3]； p <0.001）和更大百分比的坏死芯（34.0％[IQR：29.0％至44.5％] vs. 20.5％（IQR：10.0％） ；至29.0％]（p <0.001）；相反，纤维化组织的百分比较低（44.0％[IQR：32.0％至47.0％]与56.0％[IQR：46.0％至66.0％]； p = 0.001），而脂质组织和钙化组织没有差异。结论在初次经皮冠状动脉介入治疗后，通过光学相干断层扫描发现的未发现的元凶破裂是常见的，并且被发现与愈合过程中显着的管腔减少有关。
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