title: Optical coherence tomography-guided primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients: a pilot study.
abstract: BACKGROUND
  The objective of our study was to assess whether optical coherence tomography (OCT) guidance could guide intervention to avoid balloon angioplasty and stenting during primary percutaneous coronary intervention.
  
  
  METHODS
  One hundred patients with ST-segment elevation myocardial infarction and thrombus-containing lesion were enrolled in this study. Thrombus aspiration was performed in all cases followed by an OCT study. After thrombectomy, no stent was implanted in residual significant stenosis (> 50%) if examination using OCT suggested that the occlusion was mostly thrombotic, provided that the patient was symptom-free and the Thrombolysis in Myocardial Infarction (TIMI) flow was ≥ 2. All patients managed only using thrombectomy underwent 1-week and 9-month angiography and OCT. Patients with significant lesion or those in whom thrombectomy failed to re-establish flow underwent standard treatment.
  
  
  RESULTS
  Based on the OCT information, 20 patients (20%) were treated only with aspiration even in the presence of angiographically detected "high-grade stenosis." Angiogram and OCT performed at 1 week and 9 months showed a "normal vessel" without significant stenosis in all 20 cases. There were no cases of major adverse cardiovascular event (including death, myocardial infarction, and target lesion revascularization) during the in-hospital period or at the 12-month follow-up.
  
  
  CONCLUSIONS
  The results of our pilot study suggest that ST segment elevation myocardial infarction patients with TIMI 2/3 flow in the angiogram and without significant coronary narrowing using OCT examination (even in the presence of angiographically detected "high-grade stenosis"), in whom thrombus aspiration is performed in addition to optimal medical therapy might benefit only from thrombus aspiration without plain old balloon angioplasty/stenting during primary percutaneous coronary intervention. Validation of these preliminary data in larger randomized studies is warranted.
authors.affiliation: First Department of Internal Medicine-Cardioangiology, Faculty Hospital Hradec Králové, Hradec Králové, Czech Republic; Department of Cardiology, Krajská zdravotní a.s., Masaryk hospital and UJEP, Ústí nad Labem, Czech Republic. Electronic address: pavel.cervinka@mnul.cz.
authors.forename: Pavel
authors.initials: P
authors.lastname: Cervinka
authors.affiliation: Department of Cardiology, Krajská zdravotní a.s., Masaryk hospital and UJEP, Ústí nad Labem, Czech Republic.
authors.forename: Radim
authors.initials: R
authors.lastname: Spaček
authors.affiliation: Department of Cardiology, Krajská zdravotní a.s., Masaryk hospital and UJEP, Ústí nad Labem, Czech Republic.
authors.forename: Marian
authors.initials: M
authors.lastname: Bystroň
authors.affiliation: Department of Cardiology, Krajská zdravotní a.s., Masaryk hospital and UJEP, Ústí nad Labem, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Kvašňák
authors.affiliation: Department of Cardiology, Krajská zdravotní a.s., Masaryk hospital and UJEP, Ústí nad Labem, Czech Republic.
authors.forename: Andrej
authors.initials: A
authors.lastname: Kupec
authors.affiliation: First Department of Internal Medicine-Cardioangiology, Faculty Hospital Hradec Králové, Hradec Králové, Czech Republic.
authors.forename: Michaela
authors.initials: M
authors.lastname: Cervinková
authors.affiliation: Department of Cardiology and Internal Diseases, Faculty Hospital Brno and Medical Faculty Masaryk University, Brno, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Kala
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy; D003328:Coronary Thrombosis / Q000145:classification / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010865:Pilot Projects; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging; D011446:Prospective Studies; D015607:Stents / Q000706:statistics & numerical data; D017131:Thrombectomy; D041623:Tomography, Optical Coherence