Columbia University Medical Center, New York, NY, USA Cardiovascular Research Foundation, 111 East 59th Street, 12th Floor, New York, NY 10022, USA.
Division of Cardiology, Careggi Hospital, Florence, Italy.
Eur Heart J Cardiovasc Imaging. 2015 Dec;16(12):1381-9. doi: 10.1093/ehjci/jev105. Epub 2015 Apr 24.
The objective was to assess in vivo culprit lesion morphologies that caused ST-segment elevation myocardial infarction (STEMI) using optical coherence tomography (OCT).
Culprit lesions in 80 patients presenting within 6 h of STEMI onset from the CompariSon of Manual Aspiration with Rheolytic Thrombectomy in patients undergoing primary PCI (SMART) trial were evaluated. Underlying morphology of 64 culprit lesions was identifiable by OCT and included 37 lesions with plaque rupture, 25 lesions without plaque rupture, and 2 lesions with calcified nodules. Patients with plaque rupture tended to be younger (64 ± 12 versus 70 ± 10 years, P = 0.08) and less often female (11 versus 40%, P = 0.007) compared with patients without plaque rupture. More thin-cap fibroatheromas were identified (60 versus 20%, P = 0.002); and residual thrombus was greater in the rupture than in the non-rupture group. OCT at 6 months showed more stent malapposition (65 versus 33%, P = 0.04) in the rupture compared with the non-rupture group.
OCT analysis showed two dominant culprit lesion morphologies in STEMI: (i) lesions with plaque rupture with a large amount of thrombus or (ii) lesions without plaque rupture and a lesser amount of thrombus.
本研究旨在利用光学相干断层扫描（OCT）评估导致 ST 段抬高型心肌梗死（STEMI）的罪犯病变的体内形态。
对 SMART 试验中 80 例 STEMI 发病 6 小时内的罪犯病变进行了评估。64 个罪犯病变的潜在形态可通过 OCT 识别，包括 37 个斑块破裂病变、25 个无斑块破裂病变和 2 个钙化结节病变。与无斑块破裂病变患者相比，斑块破裂病变患者更年轻（64±12 岁 vs 70±10 岁，P=0.08），女性比例更低（11% vs 40%，P=0.007）。更易识别出薄帽纤维粥样斑块（60% vs 20%，P=0.002）；破裂组的残余血栓更多。6 个月时 OCT 显示破裂组支架贴壁不良（65% vs 33%，P=0.04）较非破裂组更为严重。
OCT 分析显示 STEMI 的两种主要罪犯病变形态：（i）斑块破裂伴大量血栓的病变，或（ii）无斑块破裂且血栓较少的病变。
