Cor Vasa 2012, 54(9-10):e290-e294 | DOI: 10.1016/j.crvasa.2012.05.017

OCT study in detection of thin cap fibroatheromas in STEMI patients

Pavel Červinka^a,*, Radim Špaček^a, Marian Bystroň^a, Martin Kvašňák^a, Andrej Kupec^a, Michaela Červinková^b, Petr Kala^c

^a Klinika kardiologie, Univerzita J. E. Purkyně a Krajská zdravotní, a. s., Masarykova nemocnice, Ústí nad Labem, Česká republika

^b I. interní kardioangiologická klinika, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Hradec Králové, Hradec Králové, Česká republika

^c Interní kardiologická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Brno, Česká republika

Aim: Using an optical coherence tomography (OCT) to assess plaque characterisation of culprit lesion of infarct--related vessel and to detect possible thin cap fibroatheromas (TCFA) of noninfarcted vessels in patients with ST elevation myocardial infarction (STEMI) treated with primary PCI (pPCI).

Method: 30 consecutive patients with single vessel disease and STEMI were enrolled in the study. OCT study of the culprit lesion of infarct-related vessel was performed initially after the insertion of intracoronary wire either with or without lesion predilatation. Final OCT of culprit lesion after stenting/aspiration and also other two non-infarcted vessels was performed after pPCI.

Results: Culprit lesion was mainly located in right coronary artery (RCA) (57%) followed by left anterior -descending artery (LAD) (30%). Plaque rupture of culprit lesion was found in 10 (70%) patients. In the infarct---related/culprit lesion, TCFA and thrombus was found in 100% of cases. Plaque rupture was recognized in 70% of lesions. In the OCT findings of non-infarcted vessels, the frequency of TCFAs was 47%. In the majority of cases (37%), only 1 non-infarct-related vessel was involved. However, 3 patients (10%) have TCFAs in both non-infarcted arteries. Moreover, plaque rupture and thrombus formation were found in 23% of cases of non-infarct-related vessels. Both, 30-day and 6-month follow-ups were uneventful.

Conclusions: Present study demonstrates high frequency of OCT-derived TCFA, plaque ruptures and thrombus of both, infarct- and non-infarct-related coronary vessels in patients with evolving STEMI. Our findings support the theory of multifocal destabilization in ACS.

Keywords: Optical coherence tomography; Plaque rupture; ST-elevation myocardial infarction; Unstable plaques

Received: May 1, 2012; Revised: May 23, 2012; Accepted: May 24, 2012; Published: September 1, 2012  Show citation