title: Residual atherothrombotic material after stenting in acute myocardial infarction--an optical coherence tomographic evaluation.
abstract: BACKGROUND
  Thrombus aspiration (TA) in patients with ST segment elevation myocardial infarction (STEMI) results in a better myocardial perfusion. Optical coherence tomography (OCT) after stenting in STEMI, however, often reveals residual atherothrombotic material. We assessed the feasibility of quantification of residual atherothrombotic burden and its relation to indices of myocardial perfusion. The effect of TA on residual in-stent atherothrombotic burden (ATB) is explored.
  
  
  RESULTS
  Forty patients with STEMI within 12h of symptom onset, underwent OCT after stent implantation. No complication related to the invasive imaging was detected and all cases had good image quality. All 40 cases revealed ATB (median, range; 2.85, 0.08-8.84) despite an optimal angiographic result. Patients were divided into two groups according to the ATB: ≥ 4=ATB(high) (n=15) and <4=ATB(low) (n=25). Patients with ATB(low) more often obtained a myocardial blush grade (MBG) of 2/3: 24 (96%) vs. 11 (73%), p=0.04 and a ≥ 50% ST segment resolution 24 (96%) vs. 8 (53%) p=0.02. Incomplete stent apposition is more often detected with ATB(low): 1.97 (0.62-4.73) vs. 0.33 (0.04-0.92), p=0.002. TA was performed in 20 (50%) patients. ATB was numerically lower in patients with TA: 2.37 (1.70-5.10) vs. 3.40 (1.45-4.96), p=0.67. Logistic regression identified ATB as predictor of ST resolution failure (OR: 2.5 (95% confidence interval: 1.27-4.98), p value=0.008).
  
  
  CONCLUSIONS
  OCT can be safely performed in patients presenting for primary PCI and allows quantification of residual atherothrombotic material, the amount of which is associated with worse myocardial perfusion.
authors.affiliation: Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Michael
authors.initials: M
authors.lastname: Magro
authors.forename: Evelyn
authors.initials: E
authors.lastname: Regar
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Gutiérrez-Chico
authors.forename: Hector
authors.initials: H
authors.lastname: Garcia-Garcia
authors.forename: Cihan
authors.initials: C
authors.lastname: Simsek
authors.forename: Carl
authors.initials: C
authors.lastname: Schultz
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: van Geuns
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D015607:Stents; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D041623:Tomography, Optical Coherence / Q000379:methods*
chemical_list: D000925:Anticoagulants