Columbia University Medical Center, New York, NY, USA.
Circ Cardiovasc Interv. 2011 Jun;4(3):239-47. doi: 10.1161/CIRCINTERVENTIONS.110.959791. Epub 2011 May 17.
Small stent area and residual inflow/outflow disease have been reported as the strongest intravascular ultrasound (IVUS) predictors of early stent thrombosis (ST) in patients with stable angina. IVUS predictors of early ST in patients with acute myocardial infarction have not been studied.
In the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) study, a formal substudy included poststent and 13-month follow-up IVUS at 36 centers. Twelve patients with baseline IVUS who had definite/probable early ST ≤30 days after enrollment were compared with 389 patients without early ST. Significant residual stenosis was a lumen area <4.0 mm(2) with ≥70% plaque burden ≤10 mm from each stent edge. Significant edge dissection was more than medial dissection with lumen area <4 mm(2) or dissection angle ≥60°. Randomization to bivalirudin (P=0.29) or paclitaxel-eluting stent (P=0.74) was not related to early ST. Minimum lumen area was smaller in patients with versus without early ST (4.4 mm(2) [3.6, 6.9] versus 6.7 mm(2) [5.3, 8.0], respectively, P=0.014). Minimum lumen area <5 mm(2), significant residual stenosis, significant stent edge dissection, and significant tissue (plaque/thrombus) protrusion (more than the median that narrowed the lumen to <4 mm(2)) were more prevalent in patients with early ST, but significant acute malapposition (more than the median) was not. Overall, 100% of patients with early ST had at least 1 of these significant features: minimum lumen area <5 mm(2), edge dissection, residual stenosis, or tissue protrusion versus 23% in patients without early ST (P<0.01).
Smaller final lumen area and inflow/outflow disease (residual stenosis or dissection) but not acute malapposition were related to early ST after acute myocardial infarction intervention.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.
小支架面积和残留的流入/流出病变被报道为稳定型心绞痛患者支架内血栓形成（ST）的最强血管内超声（IVUS）预测因素。急性心肌梗死患者支架内早期 ST 的 IVUS 预测因素尚未研究。
在急性心肌梗死血管成形术和支架治疗的协调结果研究（HORIZONS-AMI）中，一个正式的子研究包括支架置入后和 36 个中心的 13 个月随访 IVUS。在基线 IVUS 检查中，有 12 例患者发生了明确/可能的早期 ST，时间在入组后 30 天内，将其与 389 例无早期 ST 的患者进行了比较。显著残余狭窄是指支架边缘各 10mm 内的斑块负荷≥70%，管腔面积<4.0mm2。严重边缘夹层是指管腔面积<4mm2或夹层角度≥60°的中膜夹层更多。随机分组接受比伐卢定（P=0.29）或紫杉醇洗脱支架（P=0.74）与早期 ST 无关。早期 ST 患者的最小管腔面积小于无早期 ST 患者（分别为 4.4mm2[3.6,6.9]和 6.7mm2[5.3,8.0]，P=0.014）。早期 ST 患者的最小管腔面积<5mm2、显著残余狭窄、严重支架边缘夹层和显著组织（斑块/血栓）突入（突入狭窄至<4mm2 的管腔中位数以上）更为常见，但严重急性贴壁不良（突入中位数以上）则不常见。总体而言，100%的早期 ST 患者至少有一个以下显著特征：最小管腔面积<5mm2、边缘夹层、残余狭窄或组织突入，而无早期 ST 的患者为 23%（P<0.01）。
急性心肌梗死介入治疗后，较小的最终管腔面积和流入/流出病变（残余狭窄或夹层）而不是急性贴壁不良与早期 ST 相关。
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