The aim Using an optical coherence tomography (OCT) to assess plaque characterization of culprit lesion of infarct related vessel and to detect possible thin cap fibroatheromas (TCFA) of noninfarcted vessels in patients with ST elevation myocardial infarction (STEMI) treated with primary PCI (pPCI). Method 30 consecutive patients with single vessel disease and STEMI were enrolled in the study. OCT study of the culprit lesion of infarct related vessel was performed initially after the insertion of intracoronary wire either with or without lesion predilatation. Final OCT of culprit lesion after stenting/aspiration and also other two non-infarcted vessels was performed after pPCI. Results Culprit lesion was mainly located in right coronary artery (RCA) (57%) followed by left anterior descending artery (LAD) (30%). Plaque rupture of culprit lesion was found in 10 (70%) patients. In the infarct-related/culprit lesion, TCFA and trombus was found in 100% of cases. Plaque rupture was recognized in 70% of lesions. In the OCT findings of non-infarct vessels, the frequency of TCFAs was 47%. In the majority of cases (37%), only 1 non-infarct related vessel was involved. However, 3 patients (10%) have TCFAs in both non-infarcted arteries. Moreover, plaque rupture and thrombus formation were found in 23% of cases of non-infarcted related vessels. Both, 30-day and 6-month follow-ups were uneventful. Conclusions Present study demonstrates high frequency of OCT-derived TCFA, plaque ruptures and thrombus of both, infarct and noninfarct-related coronary vessels in patients with evolving STEMI. Our findings support the theory of multifocal destabilization in ACS.

1 interní kardioangiologická klinika LF UK a FN Hradec Králové

Interní kardiologická klinika LF MU a FN Brno

Klinika kardiologie Univerzita J E Purkyně a Krajská zdravotní a s Masarykova nemocnice Ústí nad Labem

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