Treatment Of Four Cases Of Acute ST-Segment Elevation Myocardial Infarction With Thrombus Aspiration Combined With Antithrombotic Regimen Guided By Optical Coherence Tomography

Objective:The basic pathological features of acute myocardial infarction include plaque rupture,plaque erosion,and calcified nodules.Primary percutaneous coronary intervention(p PCI)is currently considered to be the most effective reperfusion therapy for acute ST-segment elevation myocardial infarction(STEMI).Recently,EROSION I study has shown that part of the patients with acute myocardial infarction due to plaque erosion are safe and feasible by administering effective antithrombotic therapy without coronary stenting.EROSION II is a large randomized,multi-center registration study that is currently underway.This study aimed to assess whether patients with STEMI caused by plaque rupture might be stabilized by anti-thrombotic therapy without stent implantation.In our hospital,4 cases of STEMI patients confirmed by OCT that the culprit lesion was plaque rupture without severe fixed stenosis were only treated with thrombus aspiration combined with antithrombotic therapy.We summarized the characteristics and prognosis of these cases.Methods: To report 4 cases of STEMI patients with ruptured plaque who were successfully treated with antithrombotic therapy without stenting after thrombus aspiration.Using the words "acute ST-segment elevation myocardial infarction,optical coherence tomography,primary percutaneous coronary intervention,plaque rupture" as keywords,to search the Wanfang database,CNKI,CMB and Pubmed,and Summarize the relevant literature and case reports.Results: At 1 month follow-up,none of the 4 patients had major adverse cardiac events.The results of OCT examination in 4 patients showed that the diameter of the coronary lumen increased,the cross-sectional area increased,and the stenosis was less than before,FFR?0.75.During an average of 5.4 months(3-7.5 months)of follow-up,none of the 4 patients had major adverse cardiac events.Conclusion: For patients with STEMI who diagnosed with plaque rupture by optical coherence tomography(OCT)and residual diameter stenosis<70% on coronary angiogram,it may be reasonable to treat with manual aspiration thrombectomy and anti-thrombotic therapy without stenting.