Optical coherence tomography guided primary PCI in STEMI patients. A pilot study.
Pavel Červinka Primář Kliniky kardiologie, Krajská zdravotní a.s., Masarykova nemocnice, o.z., Czech Republic
Abstract:
Background: To assess feasibility, safety and posible merit of optical coherence tomography (OCT) in a setting of primary PCI in ST-elevation myocardial infarction (STEMI) patiens and one-vessel disease.
Method: 10 consecutive patients were enrolled in this study. Patients were pre-treated according to a standard medical practice. After an insertion of a wire, a thromboaspiration was employed in all cases. OCT study was performed using non-occlusive technique. If OCT recognizes only thrombus without significant stenosis and coronary angiogram was showing either TIMI 2 or 3 without significant narrowing, the procedure was stopped and patient was transffered to a CCU. A one-week follow-up coronary angiogram and OCT study were mandatory for these patiens. Major adverse cardiovascular events (MACE) including death, myocardial infarction (MI) and repeat intervention were assessed in-hospital as well as at 30-days.
Result: Mean age of STEMI group was 47 years, 80% were males. Left anterior descending (LAD) was the most often treated vessel (60%). TIMI 0 flow was found in 80% of cases. Based on the OCT study, 40% of procedures (4 patients) were end up only with trombo-aspiration without either balloon dilatation or stent implantation. TIMI 2/3 was observed in all these patiens. Moreover, ST segment resolution>50% immediately after procedure was also observed in all 4 patients. One-week angiogram was showing a “normal vessel“ without significant stenosis in all 4 cases. Furthermore, one-week OCT study was showing non-obstructive unstable plaque also in all cases. There was not any case of MACE neither in-hospital, nor at 30-day follow-up.
Conclusion: The use of OCT in case of STEMI is feasible, safe and helpful. Results of our pilot study suggest that some cohort of STEMI patiens may benefit only from trombus aspiration without stent implantation. However, these preliminary data need to be prove in a larger randomized study with sufficient long-term follow-up.
The study was supported by a grant of IGA Ministry of health of the Czech Republic no. NS9824-4/2008.
