Impact of optical coherence tomography findings on clinical outcomes in ST-segment elevation myocardial infarction patients: a MATRIX (Minimizing Adverse Hemorrhagic Events by Trans-radial Access Site and angioX) OCT sub-study.

Autor: Yacob O; MedStar Washington Hospital Center, Washington, DC, USA., Garcia-Garcia HM; MedStar Washington Hospital Center, Washington, DC, USA. hector.m.garciagarcia@medstar.net., Dan K; MedStar Washington Hospital Center, Washington, DC, USA., Soud M; Rutgers New Jersey Medical School, Newark, NJ, USA., Adamo M; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardio-Thoracic Department, University of Brescia, Brescia, Italy., Picchi A; Cardiovascular and Neurologic Department, Misericordia Hospital, Grosseto, Italy., Sardella G; Department of Cardiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy., Frigoli E; Clinical Trials Unit, University of Bern, Bern, Switzerland., Limbruno U; Cardiovascular and Neurologic Department, Misericordia Hospital, Grosseto, Italy., Rigattieri S; Division of Cardiology, Sant'Andrea Hospital, Rome, Italy., Diletti R; Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands., Boccuzzi G; Department of Cardiology, S.G. Bosco Hospital, Torino, Italy., Zimarino M; Institute of Cardiology 'G. D'Annunzio' University, Chieti, Italy., Contarini M; Interventional Cardiology Unit Umberto I Hospital, Syracuse, Italy., Russo F; Interventional Cardiology Unit, Cardio-thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy., Calabro P; Division of Cardiology, Department of Cardiothoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy., Ando G; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy., Varbella F; Cardiology Unit, Ospedali Riuniti Di Rivoli, Turin, Italy., Garducci S; Unita' Operativa Complessa Di Cardiologia ASST Di Vimercate (MB), Vimercate, Italy., Palmieri C; Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Pisa/Massa, Italy., Briguori C; Department of Cardiology, Clinica Mediterranea, Napoli, Italy., Kuku KO; MedStar Washington Hospital Center, Washington, DC, USA., Karagiannis A; Clinical Trials Unit, University of Bern, Bern, Switzerland., Valgimigli M; Swiss Cardiovascular Center, University of Bern, Bern, Switzerland. marco.valgimigli@insel.ch.
Jazyk: angličtina
Zdroj: The international journal of cardiovascular imaging [Int J Cardiovasc Imaging] 2021 Apr; Vol. 37 (4), pp. 1143-1150. Date of Electronic Publication: 2020 Nov 22.
DOI: 10.1007/s10554-020-02098-8
Abstrakt: Purpose: To investigate the association of the degree of stent expansion, as assessed by optical coherence tomography (OCT), following stent implantation, and clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients.
Methods: STEMI patients from the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and angioX) OCT study were selected; Clinical outcomes were collected through 1 year. Stent expansion index is a minimum stent area (MSA) divided by average lumen area (average of proximal and distal reference lumen area). The following variables were measured: MSA (< 4.5mm 2 ), dissection (> 200 µm in width and < 5 mm from stent segment), malapposition (> 200 µm distance of stent from vessel wall), a thrombus (area > 5% of lumen area) were compared.
Results: A total of 151 patients were included; after excluding patients with suboptimal OCT quality, the population with available OCT was classified into 2 groups: under-expanded < 90% (N = 72, 51%) and well-expanded ≥ 90% (N = 67, 49%). In the well-expanded group, a significant number of the proximal vessels had a lumen area < 4.5mm 2 (16.1%, p < 0.001) and a greater thrombus burden within stent (56.7%, p = 0.042). The overall 30 day and 1 year major adverse cardiovascular event (MACE) rates were 5% and 6.1%, respectively.
Conclusion: Irrespective of the degree of stent expansion, the OCT findings, in STEMI patients, and the MACE at 30 days and one year follow up was low; further, well-expanded stents led to a more significant residual thrombotic burden within the stent but seemed to have insignificant clinical impact. Acknowledged stent optimization criteria, traditionally related to worse outcomes in stable patients, do not seem to be associated with worse outcomes in this STEMI population.
Databáze: MEDLINE
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