Optical coherence tomography defined morphological features of the culprit vessel in young Indian patients presenting with acute ST-elevation myocardial infarction

The alarming increase in the incidence of myocardial infarction in young population has warranted a different approach to its management. Imaging-based study of the culprit lesion has provided a new dimension in understanding this condition. The authors aimed to study the morphological characteristics in young patients (<40 years) as defined by optical coherence tomography (OCT).

This prospective, single-centre, open-label, observational study was conducted at a tertiary care centre and enrolled all young patients presenting with ST-elevation myocardial infarction (STEMI) who fulfilled the inclusion criteria, between January 2020 and June 2022.

Out of 36 patients who underwent OCT, plaque rupture was observed in 63.89%, followed by plaque erosion in 36.11%. White thrombus was evident in the majority of patients (55.56%). As most of our patients were fibrinolized and the procedure was not a primary PCI but performed within 48 hours as a pharmacoinvasive approach, the native characteristics of the lesion and thrombus might have changed. A total of five patients underwent balloon predilatation due to a critically stenotic lesion that prevented the OCT catheter from passing distally.

Plaque rupture was the most common pathology for STEMI among young patients, with plaque erosion being another important contributor. The study also highlighted an early predilection for atherosclerotic changes in the Indian population.