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.

Yacob, Omar; Garcia-Garcia, Hector M; Dan, Kazuhiro; Soud, Mohamad; Adamo, Marianna; Picchi, Andrea; Sardella, Gennaro; Frigoli, Enrico; Limbruno, Ugo; Rigattieri, Stefano; Diletti, Roberto; Boccuzzi, Giacomo; Zimarino, Marco; Contarini, Marco; Russo, Filippo; Calabro, Paolo; Ando, Giuseppe; Varbella, Ferdinando; Garducci, Stefano; Palmieri, Cataldo; ... (2021). 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. International journal of cardiovascular imaging, 37(4), pp. 1143-1150. Springer 10.1007/s10554-020-02098-8

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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 (< 4.5mm2), 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 < 4.5mm2 (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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Frigoli, Enrico; Karagiannis Voules, Alexios and Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1569-5794

Publisher:

Springer

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

25 Nov 2020 11:01

Last Modified:

09 Apr 2021 03:20

Publisher DOI:

10.1007/s10554-020-02098-8

PubMed ID:

33225426

Uncontrolled Keywords:

Optical coherence tomography ST-segment elevation myocardial infarction Stent expansion

BORIS DOI:

10.7892/boris.148499

URI:

https://boris.unibe.ch/id/eprint/148499

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