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OPTICAL COHERENCE TOMOGRAPHY GUIDED PRIMARY PCI IN STEMI PATIENTS
E1881 JACC April 5, 2011 Volume 57, Issue 14
i2 SUMMIT OPTICAL COHERENCE TOMOGRAPHY GUIDED PRIMARY PCI IN STEMI PATIENTS i2 Poster Contributions Ernest N. Morial Convention Center, Hall F Monday, April 04, 2011, 9:30 a.m.-10:45 a.m.
Session Title: CTA/MRI, Imaging in the Cath Lab, Angiography Abstract Category: 2. Imaging in the Cath Lab; Angiography & QCA Session-Poster Board Number: 2510-546 Authors: Pavel Cervinka, Radim Spacek, Martin Kvasnak, Marian Bystron, Andrej Kupec, Krajska zdravotni a.s., Masaryk hospital, Usti nad Labem, Czech Republic Background: To assess feasibility, safety and posible merit of optical coherence tomography (OCT) in a setting of primary PCI in ST-elevation myocardial infarction (STEMI) patients and one-vessel disease. Methods: 20 consecutive patients with STEMI with a large burden of thrombus (>1cm) at the culprit lesion were enrolled in this study. Patients were pre-treated according to a standard medical practice. Thromboaspiration was employed in all cases followed by an OCT study using nonocclusive technique. If OCT recognizes only thrombus without significant stenosis and coronary angiogram was showing either TIMI 2 or 3 without significant narrowing, the procedure was stopped. A one-week and 6-month follow-up coronary angiogram and OCT study were mandatory for these patiens. Major adverse cardiovascular events (MACE) including death, myocardial infarction (MI) and repeat intervention were assessed in-hospital , and at 30 day and 6 month follow-up. Results: Mean age of this group was 47 years, 80% were males. Left anterior descending (LAD) was the most often treated vessel (60%). Initially, TIMI 0 flow was found in 80% of cases. Based on the OCT study, 70% of procedures (14 patients) were end up only with trombo-aspiration without either balloon dilatation or stent implantation. TIMI 2/3 was observed in all these patiens. e was also observed in all 14 patients. One-week angiogram was showing a “normal vessel“ without significant stenosis in all 14 cases. Furthermore, one-week OCT study was showing non-obstructive unstable plaque also in all cases. Moreover, 6-month coronary angiogram and OCT study did not show progression of culprit lesion. There was not any case of MACE neither in-hospital, at 30-day follow-up nor at 6-month follow-up. Conclusions: The use of OCT in case of STEMI is feasible, safe and helpful. Results of our pilot study suggest that some cohort of STEMI patiens (those with large burden of thrombus) may benefit only from trombus aspiration without stent implantation. However, these preliminary data need to be prove in a larger randomized study with sufficient long-term follow-up. The study was supported by a grant of IGA Ministry of health of the Czech Republic no. NS9824-4/2008.
i2 SUMMIT OPTICAL COHERENCE TOMOGRAPHY GUIDED PRIMARY PCI IN STEMI PATIENTS i2 Poster Contributions Ernest N. Morial Convention Center, Hall F Monday, April 04, 2011, 9:30 a.m.-10:45 a.m.
Session Title: CTA/MRI, Imaging in the Cath Lab, Angiography Abstract Category: 2. Imaging in the Cath Lab; Angiography & QCA Session-Poster Board Number: 2510-546 Authors: Pavel Cervinka, Radim Spacek, Martin Kvasnak, Marian Bystron, Andrej Kupec, Krajska zdravotni a.s., Masaryk hospital, Usti nad Labem, Czech Republic Background: To assess feasibility, safety and posible merit of optical coherence tomography (OCT) in a setting of primary PCI in ST-elevation myocardial infarction (STEMI) patients and one-vessel disease. Methods: 20 consecutive patients with STEMI with a large burden of thrombus (>1cm) at the culprit lesion were enrolled in this study. Patients were pre-treated according to a standard medical practice. Thromboaspiration was employed in all cases followed by an OCT study using nonocclusive technique. If OCT recognizes only thrombus without significant stenosis and coronary angiogram was showing either TIMI 2 or 3 without significant narrowing, the procedure was stopped. A one-week and 6-month follow-up coronary angiogram and OCT study were mandatory for these patiens. Major adverse cardiovascular events (MACE) including death, myocardial infarction (MI) and repeat intervention were assessed in-hospital , and at 30 day and 6 month follow-up. Results: Mean age of this group was 47 years, 80% were males. Left anterior descending (LAD) was the most often treated vessel (60%). Initially, TIMI 0 flow was found in 80% of cases. Based on the OCT study, 70% of procedures (14 patients) were end up only with trombo-aspiration without either balloon dilatation or stent implantation. TIMI 2/3 was observed in all these patiens. e was also observed in all 14 patients. One-week angiogram was showing a “normal vessel“ without significant stenosis in all 14 cases. Furthermore, one-week OCT study was showing non-obstructive unstable plaque also in all cases. Moreover, 6-month coronary angiogram and OCT study did not show progression of culprit lesion. There was not any case of MACE neither in-hospital, at 30-day follow-up nor at 6-month follow-up. Conclusions: The use of OCT in case of STEMI is feasible, safe and helpful. Results of our pilot study suggest that some cohort of STEMI patiens (those with large burden of thrombus) may benefit only from trombus aspiration without stent implantation. However, these preliminary data need to be prove in a larger randomized study with sufficient long-term follow-up. The study was supported by a grant of IGA Ministry of health of the Czech Republic no. NS9824-4/2008.