title: OCT-based diagnosis and management of STEMI associated with intact fibrous cap.
abstract: In autopsy studies, at least 25% of thrombotic coronary occlusions are caused by plaque erosion in which thrombus often overlies atherosclerotic plaque without evident disruption of the fibrous cap. We performed optical coherence tomography imaging after aspiration thrombectomy and identified plaque erosion as the cause in 31 patients presenting with ST-segment elevation myocardial infarction. Plaque erosion was identified when the fibrous cap of the culprit lesion was intact. Based on clinical criteria, 40% of patients with subcritically occlusive plaque were treated with dual antiplatelet therapy without percutaneous revascularization (group 1), and the remaining 60% of patients underwent angioplasty and stenting (group 2). At a median follow-up of 753 days, all patients were asymptomatic, regardless of stent implantation. These observations support an alternative treatment strategy for patients with acute coronary events and optical coherence tomography-verified intact fibrous cap (or plaque erosion), where nonobstructive lesions might be managed without stenting.
authors.affiliation: Department of Interventional Cardiology, San Giovanni Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
authors.forename: Shiro
authors.initials: S
authors.lastname: Uemura
authors.forename: Geraud
authors.initials: G
authors.lastname: Souteyrand
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
authors.forename: Luca
authors.initials: L
authors.lastname: Di Vito
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Jonathan
authors.initials: J
authors.lastname: Halperin
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ozaki
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D003328:Coronary Thrombosis / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D018579:Patient Selection; D058226:Plaque, Atherosclerotic; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D015607:Stents; D017131:Thrombectomy; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors