Coronary Optical Coherence Tomography To Guide Interventional Treatment Of Acute Myocardial Infarction

Part ?The relationship between the types of plaques in patients with acute myocardial infarction and the "suboptimal" imaging features of optical coherence tomography and short-term prognosisObjective To explore the relationship between different types of plaques in patients with acute myocardial infarction and "suboptimal" imaging features of optical coherence tomography and short-term prognosis.Methods A total of 111 patients with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention and optical coherence tomography were consecutively enrolled in Fuwai hospital from March 2017 to April 2018.Demographic data,concomitant diseases,coronary angiography and optical coherence tomography characteristics of the patients were collected.Results Among the 111 cases,58 were plaque rupture,49 were plaque erosion and 4 were calcified nodules.After stent implantation,dissection at the proximal stent edge occurred in 10.3%,6.1%and 25%of patients with plaque rupture,plaque erosion and calcified nodules,respectively.Dissection at the distal stent edge occurred in 10.3%,6.1%and 50%respectively.Stent malapposition occurred in 41.4%,40.8%and 0%of the cases,respectively.Plaque/thrombus prolapse occurred in 48.3%,55.1%and 50.0%,respectively.Except for the maximum width of prolapse of plaque erosion patients was significantly greater than that of patients with plaque rupture and calcified nodules(0.62mm to 0.49mm and 0.39mm,P<0.05),there was no significant difference between different plaque types for other "suboptimal" imaging features.At 1 month of follow-up,there was no significant difference in ischemic events and hemorrhagic events between different plaque types.Conclusion There was no difference in the "suboptimal" imaging features and short-term prognosis between different plaque types in patients with acute myocardial infarction.Part ?Comparation of six-month follow-up results of primary percutaneous coronary intervention guided by optical coherence tomography or coronary angiographyObjective Small sample studies have shown that primary coronary intervention(PPCI)guided by optical coherence tomography(OCT)can improve immediate procedure outcomes in patients with acute ST-segment elevation myocardial infarction(STEMI),but follow-up results have been reported differently.The purpose of this study was to compare the 6-month follow-up results of PPCI guided by OCT with those guided by coronary angiography(CAG)alone in a larger sample of STEMI patients.Methods We evaluated 275 STEMI patients STEMI undergoing OCT-guided PPCI from March 2017 through December 2018.These 275 patients were matched with other 275 patients guided by CAG alone from PPCI patient database in order of 1:1 by propensity score.The effects of the two strategies on 6-month clinical follow-up results were compared and evaluated.The demographic data,complications,coronary angiography and OCT characteristics of all selected patients were collected,and all patients underwent 6-month clinical follow-up.Results OCT evaluation showed that 151 patients(54.9%)had plaque prolapse and 113 patients(41.1%)had stent malapposition.Proximal and/or distal dissection of stents occurred in 38 patients(13.8%),of which 3 patients(1.1%)had both proximal and distal dissection.Of the 38 patients,2 needed to undergo rescue stent implantation.Clinical follow-up at 6 months,compared with 275 patients of PPCI guided by CAG alone and sequentially matched,there was no significant difference in cardiovascular death,repeat myocardial infarction,target vessel revascularization,stroke and hemorrhage endpoint events in those OCT-guided PPCI patients(P=0.682).Conclusions Clinical events did not reduced in OCT-guided PPCI patients compared with those guided by CAG alone.Part ?Coronary angiographic predictors of side branch occlusion in patients presenting with ST-elevation myocardial infarctionObjective To explore the predictive factors of the side branch occlusion in patients with ST-segment elevation myocardial infarction by coronary angiography.Methods A total of 1223 patients with acute ST segment elevation myocardial infarction underwent primary percutaneous coronary intervention were consecutively enrolled in Fuwai hospital from January 2014 to December 2015.According to the coronary angiography there were 256 patients with bifurcation in culprit lesions.Demographic data,past medical history and coronary angiography characteristics were collected in all patients.Results Among the 256 patients,there were 33 patients with branch occlusion,223 patients without branch occlusion.Multivariate analysis demonstrated that severe stenosis of side branch ostium(odds ratio 1.06,95%confidence interval:1.03-1.09).P<0.001)and thrombus in side branch ostium(odds ratio 5.43,95%confidence interval:1.23-23.93;P=0.025)were independent risk factors for predicting branch occlusion.Conclusion Side branch occlusion in culprit lesions of the patients with ST-segment elevation myocardial infarction is related to the severity of branch ostium stenosis and thrombosis in branch ostium.