Process Chemistry and Drug Manufacturing (Track)

OCT study in a Detection of Unstable Plaques in STEMI patients

Pavel Cervinka
Department of Cardiology, Krajská zdravotní a.s., Masaryk hospital Ústí nad Labem,o.z. Czech Republic

Abstract:

The aim: Using an optical coherence tomography (OCT) to assess plaque characterisation of culprit lesion of infarct related vessel and also to detect possible unstable plaques of non-infarcted vessel in patients with ST elevation myocardial infarctioon (STEMI) treated with primary PCI (pPCI) and one-vessel disease.

Method: 14  consecutive patients with single vessel disease and STEMI were enrolled in the study after the informed consent has been signed. OCT study (using non-occlusive systém) of the culprit lesion of infarct related  vessel was performed initially after the insertion of intracoronary wire either with or without lesion predilatation (using 1.5 mm balloon).  Final OCT of culprit lesion after stenting/aspiration and also other two non-infarcted vessels was performed at the end of procedure. Blood samples were collected immediatelly prior to the pPCI and 24 hours after the pPCI to assess hsCRP, BNP, homocystein, apolipoprotein A and B.

Results: The majority of patients were males (80%), mean age was 47.3 years. 60% of patients had 4 risk factors. Increase level of hSCRP  on admission was seen in 11 patients (80%). Culprit lesion was mainly located in left anterior descending (LAD) (50%), followed by right coronary artery (40%). Plaque rupture of culprit lesion was found in 10 (70%) patients. Among 14 patients, 8 (60%)  had 1 unstable plaque, 4 (30)% 2 unstable plaques and 1 (7%) had 3 unstable plaques in non-culprit vessel. There were not any peri-procedural complications related to the OCT study.

Conclusions: Based on OCT study, plaque rupture of culprit lesion was found in 70% of STEMI patients. Furthermore, majority (60%) of STEMI patients also had unstable plaques in non-culprit lesions. OCT-related complications were not seen in this study.

The study was supported by a grant of IGA Ministry of health of the Czech Republic no. NS9824-4/2008.