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Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
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Association Between Preinfarction Angina and Culprit Lesion Morphology in Patients With ST-Segment Elevation

Ying Wang1, Zhaoxue Sheng1,2, Jiannan Li1

  • 1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.

Frontiers in Cardiovascular Medicine
|February 4, 2022
PubMed

Insights

Preinfarction angina (PIA) in ST-segment elevation myocardial infarction (STEMI) patients is linked to less plaque rupture and lipid-rich plaques. This suggests distinct STEMI mechanisms in patients experiencing PIA.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Imaging

Background:

  • Preinfarction angina (PIA) may offer cardiac protection in acute myocardial infarction (AMI).
  • The role of PIA in ST-segment elevation myocardial infarction (STEMI) requires further investigation regarding culprit plaque morphology.

Purpose of the Study:

  • To identify culprit plaque morphology and clinical outcomes associated with PIA in STEMI patients.
  • To utilize optical coherence tomography (OCT) for detailed plaque analysis in STEMI with PIA.

Main Methods:

  • Prospective inclusion of 279 STEMI patients undergoing intravascular OCT of the culprit lesion.
  • Comparison of plaque characteristics and clinical outcomes between patients with and without PIA.
  • Multivariate logistic regression to identify independent predictors of plaque rupture.

Main Results:

  • 153 patients (54.8%) presented with PIA; STEMI onset with exertion was less common in the PIA group.
  • PIA patients showed significantly lower incidence of plaque rupture (40.5% vs. 61.9%) and lipid-rich plaques (48.4% vs. 69.0%).
  • PIA was an independent negative predictor of plaque rupture (OR: 0.44; 95% CI: 0.268-0.725).

Conclusions:

  • STEMI patients with PIA exhibit a lower prevalence of plaque rupture and lipid-rich plaques in the culprit lesion.
  • These findings suggest potentially different underlying mechanisms for STEMI in patients with PIA.
  • No significant differences in clinical outcomes were observed between groups, except for unplanned revascularization.
Abstract

Keywords:
ST-segment elevation myocardial infarctionlipid-rich plaqueoptical coherence tomographyplaque rupturepre-infarction angina

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