title: The influence of coronary plaque morphology assessed by optical coherence tomography on final microvascular function after stenting in patients with ST-elevation myocardial infarction.
abstract: OBJECTIVE
  The index of microcirculatory resistance (IMR) provides a reproducible assessment of the status of coronary microvasculature in patients with ST-elevation myocardial infarction (STEMI). Frequency-domain optical coherence tomography (FD-OCT) enables detailed assessment of the morphology of coronary plaque.We sought to determine the influence of the initial culprit coronary plaque anatomy within the infarct-related artery on IMR after stenting in STEMI.
  
  
  METHODS
  In 25 STEMI patients IMR was measured immediately before and after stent implantation. FD-OCT imaging was performed at the same time points and atherothrombotic volume (ATV) before stenting, prolapsed+floating ATV after stenting and ΔATV was measured using three different strategies.
  
  
  RESULTS
  There were no relationships between preprocedural IMR and FD-OCT parameters. Prestenting IMR was related only to pain to wire time (P: 0.02). Irrespective of the method adopted, the final IMR was related to prestenting ATV (ρ: 0.44, P: 0.03 for method I, ρ: 0.48, P: 0.02 for method II and ρ: 0.30, P: 0.06 for method III) and ΔATV (ρ: 0.41, P: 0.04 for method II and ρ: 0.44, P: 0.03 for method III).
  
  
  CONCLUSIONS
  IMR measured before stenting is independent of the appearances of the culprit coronary plaque within the infarct-related artery. IMR after stenting, and more importantly, the change in IMR after stenting, reflect the degree of distal embolization during stent implantation.
authors.affiliation: aOxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals bRadcliffe Department of Medicine, Acute Vascular Imaging Centre cDivision of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, Oxford, UK dCardiovascular Department, Università Cattolica del Sacro Cuore, Rome, Italy eMedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Giovanni L
authors.initials: GL
authors.lastname: De Maria
authors.forename: Niket
authors.initials: N
authors.lastname: Patel
authors.forename: Mathias
authors.initials: M
authors.lastname: Wolfrum
authors.forename: Gregor
authors.initials: G
authors.lastname: Fahrni
authors.forename: George
authors.initials: G
authors.lastname: Kassimis
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Sam
authors.initials: S
authors.lastname: Dawkins
authors.forename: Robin P
authors.initials: RP
authors.lastname: Choudhury
authors.forename: John C
authors.initials: JC
authors.lastname: Forfar
authors.forename: Bernard D
authors.initials: BD
authors.lastname: Prendergast
authors.forename: Keith M
authors.initials: KM
authors.lastname: Channon
authors.forename: Rajesh K
authors.initials: RK
authors.lastname: Kharbanda
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.forename: Adrian P
authors.initials: AP
authors.lastname: Banning
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014655:Vascular Resistance