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Published on: February 18, 2022
Longitudinal extent of lipid pool assessed by optical coherence tomography predicts microvascular no-reflow after
Hiroki Ikenaga1, Masaharu Ishihara, Ichiro Inoue
1Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
Insights
The length of the lipid pool in coronary arteries, measured by optical coherence tomography (OCT), can predict microvascular no-reflow after percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Distal embolization during percutaneous coronary intervention (PCI) can impair microvascular reperfusion in ST-elevation myocardial infarction (STEMI) patients.
- Coronary microvascular reperfusion is critical for STEMI outcomes.
- Culprit plaque characteristics, such as lipid pool extent, are linked to embolization and reperfusion.
- ST-segment resolution (ST-R) on ECG indicates microvascular reperfusion post-PCI.
Purpose of the Study:
- To investigate if the longitudinal extent of the lipid pool, assessed by optical coherence tomography (OCT), can predict the failure of microvascular reperfusion after primary PCI in STEMI patients.
- To determine the predictive value of lipid pool length for ST-segment resolution (ST-R).
Main Methods:
- A study involving 39 STEMI patients undergoing primary PCI within 24 hours of symptom onset.
- Optical coherence tomography (OCT) was performed immediately after thrombectomy to measure the length of the lipid pool.
- Microvascular reperfusion was assessed by ST-segment resolution (ST-R), defined as >50% ST elevation decrease at 1 hour post-PCI.
Main Results:
- Patients without ST-R (n=16) had a significantly longer lipid pool length (10.1 ± 2.8mm) compared to those with ST-R (n=23) (7.8 ± 3.2mm; p=0.02).
- A lipid pool length >9.0mm was identified as the best predictor for the absence of ST-R, with 88% sensitivity and 78% specificity (Area Under Curve = 0.74; p=0.02).
- Higher peak creatine kinase levels were observed in the no-ST-R group.
Conclusions:
- The longitudinal extent of the lipid pool, as measured by OCT, serves as a valuable predictor of microvascular no-reflow following primary PCI in STEMI.
- OCT-derived lipid pool assessment can aid in identifying STEMI patients at higher risk for impaired microvascular reperfusion.
Background:
Distal embolization during percutaneous coronary intervention (PCI) may deteriorate microvascular reperfusion in patients with ST-elevation myocardial infarction (STEMI). Reperfusion at the coronary microvascular level is important for STEMI and culprit plaque is associated with distal embolization and microvascular reperfusion. ST-segment resolution (ST-R) in the electrocardiogram reflects microvascular reperfusion after primary PCI. Longitudinal extent of lipid pool assessed by optical coherence tomography (OCT) may predict the risk of failure of microvascular reperfusion after primary PCI.
Methods And Results:
This study consisted of 39 patients with STEMI who underwent primary PCI within 24h after the onset of chest pain. Immediately after thrombectomy, OCT was performed and length of lipid pool was measured. Microvascular reperfusion after primary PCI was assessed by ST-R, which was defined as >50% decrease in ST elevation at 1h after primary PCI. There were 23 patients with ST-R and 16 patients without ST-R, with no significant difference in baseline clinical and angiographical variables between the 2 groups. Final thrombolysis in myocardial infarction 3 flow was obtained in all of the patients. Peak creatine kinase was significantly higher in the ST-R (-) group than in the ST-R (+) group (p=0.01). Length of lipid pool was 10.1 ± 2.8mm in the ST-R (-) group and 7.8 ± 3.2mm in the ST-R (+) group (p=0.02). In receiver operating characteristics curve assessing the ability of length of lipid pool to predict ST-R, area under the curve was 0.74 (p=0.02). Length of lipid pool >9.0mm best predicted the absence of ST-R with sensitivity 88% and specificity 78%.
Conclusions:
These findings suggest that length of lipid pool estimated by OCT may predict microvascular no-reflow after primary PCI.
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