title: Culprit plaque morphology in STEMI - an optical coherence tomography study: insights from the TOTAL-OCT substudy.
abstract: OBJECTIVE
  Our aim was to compare stenosis severity and plaque content between STEMI culprit lesions with intact fibrous cap (IFC) and those with plaque rupture (PR) in a prospective study.
  
  
  RESULTS
  We evaluated 93 patients undergoing OCT and thrombectomy as part of a prospective substudy of the TOTAL (ThrOmbecTomy versus PCI ALone) trial. Culprit lesion morphology was assessable by OCT in 70/93 (75.3%). IFC was found in 31 (44.3%), PR in 34 (48.6%) and calcified nodule in five (7.1%) patients. Following thrombectomy, OCT demonstrated similar lumen area stenosis in IFC (79.3%) and PR (79.6%) (p=0.88). Lumen area stenosis <50% was observed in none of the patients with PR and in one patient with IFC. IFC had fewer quadrants with lipid plaque as compared to PR (28.16±15.02 vs. 39.12±14.23, p=0.004). However, in both lesion types, lipid was the predominant plaque type (83.9 vs. 63.7% of diseased quadrants).
  
  
  CONCLUSIONS
  In a prospective study of STEMI patients treated with thrombectomy, mild residual stenoses were uncommon in IFC lesions. Although lipid content was lower than in PR lesions, lipid composed the majority of the diseased segments in IFC.
authors.affiliation: Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Olli A
authors.initials: OA
authors.lastname: Kajander
authors.forename: Natalia
authors.initials: N
authors.lastname: Pinilla-Echeverri
authors.forename: Sanjit S
authors.initials: SS
authors.lastname: Jolly
authors.forename: Ravinay
authors.initials: R
authors.lastname: Bhindi
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Kari
authors.initials: K
authors.lastname: Niemelä
authors.forename: Anthony
authors.initials: A
authors.lastname: Fung
authors.forename: Ram
authors.initials: R
authors.lastname: Vijayaraghavan
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.forename: Tej
authors.initials: T
authors.lastname: Sheth
mesh_terms: D000368:Aged; D057791:Cardiac Imaging Techniques; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging*; D041623:Tomography, Optical Coherence