Department of Cardiovascular Medicine, Policlinico A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
Circ Cardiovasc Interv. 2012 Feb 1;5(1):89-96, S1-6. doi: 10.1161/CIRCINTERVENTIONS.111.965624. Epub 2012 Jan 31.
Frequency-domain optical coherence tomography (FD-OCT) is easily able to define both pre- and post-stenting features of the atherosclerotic plaque that can potentially be related to periprocedural complications. We sought to examine which FD-OCT-defined characteristics, assessed both before and after stent deployment, predicted periprocedural (type IVa) myocardial infarction (MI).
FD-OCT was performed before and after coronary stenting in 50 patients undergoing percutaneous coronary intervention (PCI) for either non-ST segment elevation MI (NSTEMI) or stable angina. All patients underwent single-vessel stenting, and only drug-eluting stents were implanted. Troponin T was analyzed on admission, before PCI, and at 12 and 24 hours after PCI, and type IVa MI was defined in stable angina as a rise of at least 3× upper reference limit and in NSTEMI as a pre-PCI troponin T fall, followed by post-PCI troponin T rise >20%. Type IVa MI was diagnosed in 21 patients, while the remaining 29 represented the control group. FD-OCT analysis showed that thin-cap fibroatheroma (76.2% versus 41.4%; P=0.017) prior to PCI, intrastent thrombus (61.9% versus 20.7%; P=0.04), and intrastent dissection (61.9% versus 31%; P=0.03) after PCI were significantly more frequent in type IVa MI than in the control group. Multivariate logistic regression analysis confirmed thin-cap fibroatheroma (OR 29.7, 95% CI 1.4 to 32.1), intrastent thrombus (OR 5.5, CI 1.2 to 24.9) and intrastent dissection (OR 5.3, CI 1.2 to 24.3) as independent predictors of type IVa MI.
In conclusion, presence of thin-cap fibroatheroma at pre-PCI FD-OCT and of intrastent thrombus and intrastent dissection at post-PCI FD-OCT predict type IVa MI in a contemporary sample of patients treated with second-generation drug-eluting stents. Interestingly, 2 of the 3 predictors of type IVa MI were not apparent at pre-PCI FD-OCT.
频域光相干断层扫描（FD-OCT）可轻松定义动脉粥样硬化斑块的支架置入前后特征，这些特征可能与围手术期并发症有关。我们旨在研究 FD-OCT 定义的哪些特征，在支架置入前后进行评估，可预测围手术期（IVa 型）心肌梗死（MI）。
50 例行经皮冠状动脉介入治疗（PCI）的患者（非 ST 段抬高型 MI（NSTEMI）或稳定型心绞痛）进行了 FD-OCT 检查，这些患者在 PCI 之前和之后均进行了冠状动脉支架置入。所有患者均接受单支血管支架置入术，且仅植入药物洗脱支架。肌钙蛋白 T 在入院时、PCI 之前以及 PCI 后 12 和 24 小时进行分析，稳定型心绞痛患者中 IVa 型 MI 的定义为至少升高 3 倍参考上限，NSTEMI 患者的定义为 PCI 前肌钙蛋白 T 下降，随后 PCI 后肌钙蛋白 T 升高＞20%。21 例患者诊断为 IVa 型 MI，其余 29 例为对照组。FD-OCT 分析显示，IVa 型 MI 患者的 PCI 前存在薄帽纤维粥样斑块（76.2%与 41.4%；P=0.017）、支架内血栓（61.9%与 20.7%；P=0.04）和支架内夹层（61.9%与 31%；P=0.03）的发生率显著高于对照组。多变量逻辑回归分析证实薄帽纤维粥样斑块（OR 29.7，95%CI 1.4 至 32.1）、支架内血栓（OR 5.5，CI 1.2 至 24.9）和支架内夹层（OR 5.3，CI 1.2 至 24.3）是 IVa 型 MI 的独立预测因素。
综上所述，在接受第二代药物洗脱支架治疗的患者中，PCI 前 FD-OCT 存在薄帽纤维粥样斑块，以及 PCI 后 FD-OCT 存在支架内血栓和支架内夹层，可预测 IVa 型 MI。有趣的是，3 个 IVa 型 MI 预测因素中有 2 个在 PCI 前 FD-OCT 中并不明显。
