Impact of optical coherence tomography guided primary percutaneous coronary intervention on physician decision-making
10.3969/j.issn.1004-8812.2017.08.004
- VernacularTitle:光学相干断层成像对ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗策略的影响
- Author:
Min XU
;
Jincheng GUO
;
Rong XU
;
Guozhong WANG
;
Zijing LIU
;
Dan NIU
;
Guowang GAO
- Keywords:
Myocardial infarction;
Optical coherence tomography;
Percutaneous coronary intervention
- From:
Chinese Journal of Interventional Cardiology
2017;25(8):432-436
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the impact of optical coherence tomography(OCT) imaging on physician decision-making during primary percutaneous coronary intervention(PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods From January 2016 to May 2017, OCT was performed in 100 cases pre- and post- primary PCI. The pathogenesis of myocardial infarction was determined and immediate effect of PCI evaluated by OCT. Clinical outcome during a 12-months follow up was analyzed. Results The data from 17 patients were excluded for further study due to poor OCT images quality. The rates of plaque rupture, plaque erosion, calcification nodules, stent malapposition and coronary spasm were 65.1％(54/83), 26.5％(22/83), 3.6％(3/83), 2.4％(2/83) respectively among the remaining 83 patients with sufficient OCT quality images. of the overall rate of stent malposition, tissue prolapse and incomplete stent expansion was 21.7％(18/83). The incidence of edge dissection was 19.3％(16/83), and among them 2 patients required treatment with stent implantation. Among the 17 patients without stenting:coronary spasm were found in 2 cases, thrombus overload in 1 case after thrombus aspiration, plaque rupture in 7 cases , plaque erosion in 4 cases and stent malposition in 3 cases. One patient died in hospital for cardiogenic shock and one patient had subacute stent thrombosis . There were no major adverse cardiac events occurred in the remaining patients during the (11.0±4.0) months of follow-up. Conclusions OCT can identify nonoptimal stent deployment in approximately one-fourth of STEMI patients undergoing primary PCI, thus providing preliminary guidance to the physician for further mangement.
