Department of Cardiovascular Medicine, Wakayama Medical University.
Department of Cardiovascular Medicine, Assiut University Hospitals.
Circ J. 2022 Aug 25;86(9):1388-1396. doi: 10.1253/circj.CJ-21-1059. Epub 2022 May 11.
Patients with acute myocardial infarction (AMI) caused by calcified nodules (CN) have worse clinical outcomes following primary percutaneous coronary intervention (PCI). This study investigated the late vascular response after everolimus-eluting stent (EES) implantation assessed by optical coherence tomography (OCT) in patients with AMI caused by CN, by comparing with plaque rupture (PR) and plaque erosion (PE).
Based on the OCT findings in AMI culprit lesions before PCI, a total of 141 patients were categorized into 3 groups (PR, PE, or CN), and the OCT findings immediately and 10 months after PCI were compared. The frequency of PR, PE, and CN was 85 (60%), 45 (32%), and 11 patients (8%), respectively. In the 10-month follow-up OCT, the frequency of lesions with uncovered struts and lesions with malapposed struts were highest in the CN group, followed by the PR and PE groups (82% vs. 52% vs. 40%, P=0.042 and 73% vs. 26% vs. 16%, P<0.001, respectively). The incidence of intra-stent thrombus, re-appearance of CN within the stent, and target lesion revascularization were higher in the CN group compared with the PR and PE groups (36% vs. 9% vs. 7%, P=0.028; 27% vs. 0% vs. 0%, P<0.001; and 18% vs. 2% vs. 2%, P=0.024, respectively).
Late arterial healing response at 10 months after EES implantation in the CN was worse compared with PR and PE in patients with AMI.
原发性经皮冠状动脉介入治疗（PCI）后，由钙化结节（CN）引起的急性心肌梗死（AMI）患者的临床预后较差。本研究通过光学相干断层扫描（OCT）比较了由 CN、斑块破裂（PR）和斑块侵蚀（PE）引起的 AMI 患者在接受依维莫司洗脱支架（EES）植入后的晚期血管反应。
根据 PCI 前 AMI 罪犯病变的 OCT 发现，共有 141 例患者分为 3 组（PR、PE 或 CN），比较了 PCI 前后即刻和 10 个月的 OCT 发现。PR、PE 和 CN 的发生率分别为 85（60%）、45（32%）和 11 例（8%）。在 10 个月的 OCT 随访中，CN 组未覆盖支架的支架发生率和支架贴壁不良的发生率最高，其次是 PR 和 PE 组（82%比 52%比 40%，P=0.042 和 73%比 26%比 16%，P<0.001）。CN 组的支架内血栓形成、支架内再次出现 CN 和靶病变血运重建的发生率高于 PR 和 PE 组（36%比 9%比 7%，P=0.028；27%比 0%比 0%，P<0.001；和 18%比 2%比 2%，P=0.024）。
在 AMI 患者中，与 PR 和 PE 相比，EES 植入后 10 个月时 CN 的晚期动脉愈合反应更差。
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