Francesco Saia1, Kenichi Komukai2, Davide Capodanno3, Vasile Sirbu2, Giuseppe Musumeci2, Giacomo Boccuzzi4, Giuseppe Tarantini5, Massimo Fineschi6, Gabriele Tumminello7, Chiara Bernelli2, Giampaolo Niccoli8, Micol Coccato2, Barbara Bordoni9, Hiram Bezerra10, Giuseppe Biondi-Zoccai11, Renu Virmani12, Giulio Guagliumi2. 1. Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. Electronic address: francescosaia@hotmail.com. 2. Interventional Cardiology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy. 3. Ferrarotto Hospital, University of Catania, Catania, Italy. 4. Cardiology Department, Ospedale San Giovanni Bosco, Torino, Italy. 5. Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy. 6. Department of Cardiology, Policlinico Le Scotte, Siena, Italy. 7. Cardiology Department, Ospedale Civile, Asti, Italy. 8. Institute of Cardiology, Catholic University of the Sacred Heart, Roma, Italy. 9. Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. 10. Case Western Reserve University, Cleveland, Ohio. 11. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. 12. CV Path Institute, Gaithersburg, Maryland.
Abstract
OBJECTIVES: The aim of this study was to evaluate the pathophysiological features and response to primary percutaneous coronary intervention (PCI) of nonruptured/eroded plaque versus ruptured plaque as a cause of ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Autopsy series identified nonruptured/eroded plaque and ruptured plaque as the principal pathological substrates underlying coronary thrombosis in STEMI. The real incidence of different plaque morphologies, associated biological factors, superimposed thrombus, and their interaction with primary PCI remain largely unknown. METHODS: In a prospective study, 140 patients with STEMI underwent optical coherence tomography of the infarct-related artery (IRA) before PCI, after everolimus-eluting stent implantation and at 9-month follow-up. Histopathology and immunohistochemistry of thrombus aspirates and serum biomarkers were assessed at baseline. RESULTS: Culprit plaque morphology was adjudicated in 97 patients: 32 plaques (33.0%) with an intact fibrous cap (IFC), 63 (64.9%) plaques with a ruptured fibrous cap (RFC), and 2 (2.1%) spontaneous dissections. Patients with an IFC and RFC had similar clinical characteristics, and serum inflammatory and platelets biomarkers. An IFC presented more frequently with a patent IRA (56.2% vs. 34.9%; p = 0.047), and had fewer lipid areas (lipid-rich areas: 75.0% vs. 100.0%; p < 0.001) and less residual thrombus before stenting (white thrombus: 0.41 mm(3) vs. 1.52 mm(3); p = 0.001; red thrombus: 0 mm(3) vs. 0.29 mm(3); p = 0.001) with a lower peak of creatine kinase-myocardial band (66.6 IU/l vs. 149.8 IU/l; p = 0.025). At the 9-month optical coherence tomography, IFC and RFC had similar high rates of stent strut coverage (92.5% vs. 91.2%; p = 0.15) and similar percentage of volume obstruction (12.6% vs. 10.2%; p = 0.27). No significant differences in clinical outcomes were observed up to 2 years. CONCLUSIONS: In the present study, an IFC was observed at the culprit lesion site of one-third of STEMIs. IFC, compared with RFC, was associated with higher rates of patent IRA at first angiography, fewer lipid areas, and residual endoluminal thrombus. However, no difference in vascular response to everolimus-eluting stent was observed. (Optical Coherence Tomography Assessment of Gender Diversity in Primary Angioplasty [OCTAVIA]; NCT01377207).
OBJECTIVES: The aim of this study was to evaluate the pathophysiological features and response to primary percutaneous coronary intervention (PCI) of nonruptured/eroded plaque versus ruptured plaque as a cause of ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Autopsy series identified nonruptured/eroded plaque and ruptured plaque as the principal pathological substrates underlying coronary thrombosis in STEMI. The real incidence of different plaque morphologies, associated biological factors, superimposed thrombus, and their interaction with primary PCI remain largely unknown. METHODS: In a prospective study, 140 patients with STEMI underwent optical coherence tomography of the infarct-related artery (IRA) before PCI, after everolimus-eluting stent implantation and at 9-month follow-up. Histopathology and immunohistochemistry of thrombus aspirates and serum biomarkers were assessed at baseline. RESULTS: Culprit plaque morphology was adjudicated in 97 patients: 32 plaques (33.0%) with an intact fibrous cap (IFC), 63 (64.9%) plaques with a ruptured fibrous cap (RFC), and 2 (2.1%) spontaneous dissections. Patients with an IFC and RFC had similar clinical characteristics, and serum inflammatory and platelets biomarkers. An IFC presented more frequently with a patent IRA (56.2% vs. 34.9%; p = 0.047), and had fewer lipid areas (lipid-rich areas: 75.0% vs. 100.0%; p < 0.001) and less residual thrombus before stenting (white thrombus: 0.41 mm(3) vs. 1.52 mm(3); p = 0.001; red thrombus: 0 mm(3) vs. 0.29 mm(3); p = 0.001) with a lower peak of creatine kinase-myocardial band (66.6 IU/l vs. 149.8 IU/l; p = 0.025). At the 9-month optical coherence tomography, IFC and RFC had similar high rates of stent strut coverage (92.5% vs. 91.2%; p = 0.15) and similar percentage of volume obstruction (12.6% vs. 10.2%; p = 0.27). No significant differences in clinical outcomes were observed up to 2 years. CONCLUSIONS: In the present study, an IFC was observed at the culprit lesion site of one-third of STEMIs. IFC, compared with RFC, was associated with higher rates of patent IRA at first angiography, fewer lipid areas, and residual endoluminal thrombus. However, no difference in vascular response to everolimus-eluting stent was observed. (Optical Coherence Tomography Assessment of Gender Diversity in Primary Angioplasty [OCTAVIA]; NCT01377207).
Authors: Giovanni L De Maria; Niket Patel; Mathias Wolfrum; Gregor Fahrni; George Kassimis; Italo Porto; Sam Dawkins; Robin P Choudhury; John C Forfar; Bernard D Prendergast; Keith M Channon; Rajesh K Kharbanda; Hector M Garcia-Garcia; Adrian P Banning Journal: Coron Artery Dis Date: 2017-05 Impact factor: 1.439
Authors: Tomoyo Sugiyama; Erika Yamamoto; Krzysztof Bryniarski; Lei Xing; Hang Lee; Mitsuaki Isobe; Peter Libby; Ik-Kyung Jang Journal: JAMA Cardiol Date: 2018-03-01 Impact factor: 14.676