Key result
Residual atherothrombotic burden after primary PCI was significantly lower in STEMI patients with optimal myocardial reperfusion (MBG 3) compared to those with impaired MBG (8.15% vs 11.77%; p=.007).
Why the study?
The impact of residual in-stent atherothrombotic burden after primary PCI on myocardial reperfusion remains unclear.
Is residual in-stent atherothrombotic burden measured by OFDI associated with suboptimal myocardial reperfusion (MBG <3) after primary PCI in STEMI patients?
Observational (n=60)
Is residual in-stent atherothrombotic burden measured by OFDI associated with suboptimal myocardial reperfusion (MBG <3) after primary PCI in STEMI patients?
Residual atherothrombotic burden after primary PCI in STEMI patients correlates significantly with suboptimal myocardial reperfusion, suggesting a mechanism for impaired microvascular flow despite stenting.
Residual ATB after primary PCI was associated with impaired MBG in STEMI; hypothesis-generating for OFDI assessment, needs prospective validation.
OBJECTIVES: We aimed to assess the relationship between residual in-stent atherothrombotic burden (ATB) after primary percutaneous coronary intervention (PCI) measured by optical frequency domain imaging (OFDI) using different measurement methods and myocardial blush grade (MBG). BACKGROUND: The impact of residual ATB after primary PCI on myocardial reperfusion remains unclear. METHODS: We prospectively included 60 ST-elevation myocardial infarction patients pretreated with aspirin and ticagrelor. OFDI volumetric quantification using planimetry (with intervals every frame or every millimeter) and semiquantitative score were used to determine ATB. Patients were divided into two groups according to final MBG 3 or <3. RESULTS: The mean ATB was 10.08 ± 5.21%. ATB was lower in patients with final MBG 3 compared to those with impaired MBG, regardless of the measurement method (8.15 ± 5.58 vs. 11.77 ± 4.28%; p = .007 for quantification per frame; 7.8 ± 5.19 vs. 11.07 ± 4.07%; p = .009 for quantification per mm and 11.21 ± 11.75 vs. 22.91 ± 17.35; p = .003 for the semiquantitative thrombus score, respectively). CONCLUSION: Residual post-stenting ATB remains substantial after primary PCI in STEMI patients, even when pretreated with ticagrelor and aspirin. ATB appears as a significant correlate of suboptimal myocardial reperfusion, a known surrogate of clinical outcome.
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Roule et al. (2019) conducted an observational in ST-elevation myocardial infarction (n=60). Optical frequency domain imaging (OFDI) vs. Myocardial blush grade (MBG) <3 was evaluated on Residual in-stent atherothrombotic burden (ATB) quantification per frame (p=.007). Residual atherothrombotic burden after primary PCI was significantly lower in STEMI patients with optimal myocardial reperfusion (MBG 3) compared to those with impaired MBG (8.15% vs 11.77%; p=.007).
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