Uzu Kenzo, Shinke Toshiro, Otake Hiromasa, Takaya Tomofumi, Osue Tsuyoshi, Iwasaki Masamichi, Kinutani Hiroto, Konishi Akihide, Kuroda Masaru, Takahashi Hachidai, Terashita Daisuke, Hirata Ken-Ichi, Saito Shigeru, Nakamura Masato, Shite Junya, Akasaka Takashi
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
J Cardiol. 2017 Dec;70(6):545-552. doi: 10.1016/j.jjcc.2017.05.002. Epub 2017 Jun 12.
Previous studies have suggested that peri-procedural myocardial infarction (PMI) following percutaneous coronary intervention (PCI) is associated with adverse short- and long-term outcomes, and several morphological predictors of PMI have been studied. However, the determinants of PMI under novel anti-platelet therapy are not fully elucidated.
PRASFIT-Elective is a multicenter, parallel-group study of PCI patients in non-acute settings receiving either prasugrel or clopidogrel in addition to aspirin. Among 742 study patients, 94 (116 lesions) underwent optical coherence tomography (OCT) to evaluate the area of intra-stent tissue (IST, which comprises tissue protrusion and thrombus) after stenting in addition to standard parameters. We investigated the relationship between the peak creatine kinase (CK)-MB fraction levels after PCI and post-stent OCT findings, as well as on-treatment platelet reactivity determined by the P2Y reaction units (PRU) at PCI, in a post hoc manner. The multivariate linear analysis revealed that a larger total IST area (standardized coefficient: 0.370, p<0.001) and smaller minimal stent diameter (standardized coefficient: -0.242, p<0.014), but not the PRU value (p=0.988), were independently associated with CK-MB leakage. The IST area after stenting was mainly determined by the target lesion lipid index (averaged lipid arc×lipid length) (r=0.583, p<0.001).
Following elective PCI, a large IST area originating from a lipid-rich plaque and a smaller minimal stent diameter were associated with PMI.
既往研究表明，经皮冠状动脉介入治疗（PCI）后围手术期心肌梗死（PMI）与不良的短期和长期预后相关，并且已经对PMI的几种形态学预测因素进行了研究。然而，新型抗血小板治疗下PMI的决定因素尚未完全阐明。
PRASFIT-Elective是一项多中心、平行组研究，纳入非急性情况下接受PCI治疗的患者，这些患者除阿司匹林外还接受普拉格雷或氯吡格雷治疗。在742例研究患者中，94例（116个病变）除了标准参数外，还接受了光学相干断层扫描（OCT）以评估支架置入后支架内组织（IST，包括组织突出和血栓）的面积。我们以事后分析的方式研究了PCI后肌酸激酶（CK）-MB峰值水平与支架置入后OCT结果之间的关系，以及PCI时通过P2Y反应单位（PRU）测定的治疗期间血小板反应性。多变量线性分析显示，IST总面积较大（标准化系数：0.370，p<0.001）和最小支架直径较小（标准化系数：-0.242，p<0.014），而非PRU值（p=0.988），与CK-MB泄漏独立相关。支架置入后的IST面积主要由靶病变脂质指数（平均脂质弧×脂质长度）决定（r=0.583，p<0.001）。
择期PCI后，源自富含脂质斑块的大IST面积和较小的最小支架直径与PMI相关。
