Application and therapeutic effect evaluation of optical coherence tomography in patients with acute myocardial infarction caused by plaque rupture

doi:10.3877/cma.j.issn.2095-655X.2025.01.002

Abstract

Abstract:

Objective

To investigate the application of optical coherence tomography (OCT) in patients with acute myocardial infarction (AMI) caused by plaque rupture and evaluate the therapeutic effect.

Methods

The patients diagnosed with AMI in the Department of Cardiology of Jilin Central Hospital from January 2019 to October 2022 were selected. After emergency percutaneous coronary angiography(CAG) and intracoronary thrombus removal (manual thrombus aspiration or drug intracoronary thrombolysis),the coronary blood flow in CAG confirming culprit vessel returned to TIMI level 3. Moreover, for the patients with visual estimation of culprit lesion stenosis <70.00%, OCT examination was performed at a selected time(7 days after hospitalization). Patients meeting the following OCT-defined plaque rupture features were managed without stenting and given intensive drug theraphy (n=29): rupture arc <90°; rupture length <1 mm; absence of large free intimal flaps. CAG and OCT were reviewed 12 months after treatment, and the changes of OCT characteristics at baseline and 12 months after treatment were compared, and the occurrence of major adverse cardiovascular events (MACE) within 12 months were analyzed.

Results

OCT results of 29 patients were reviewed 12 months after treatment. Compared with the baseline OCT features, the thickness of the thin fiber cap increased [(74.66±20.79)μm, (95.21±16.31)μm], and the arc of ruptured plaque decreased [(83.69±6.30)°, (80.38±5.93)°]. The length of ruptured plaque decreased[(0.67±0.16)mm, (0.56±0.17)mm], the minimum lumen area increased [(3.58±0.55)mm², (3.82±0.69)mm²], and the depth of ruptured plaque decreased [(1 410.34±214.40)μm, (1 251.38±208.22)μm],the percent area stenosis [(64.00±4.26)%, (61.79±4.23)%] and macrophage infiltration rate decreased[68.97%(20/29), 34.48%(10/29)], and the differences were statistically significant (t=11.71, 3.59,3.55, 6.29, 9.84, 3.51, χ²=8.10, all P<0.01). After 12 months of follow-up, two patients (6.90%)were re-hospitalized for angina pectoris, of whom one patient showed no stenosis progression on follow-up CAG, and the other patient underwent stenting for a non-culprit lesion progression. No serious MACE occurred during follow-up.

Conclusions

After removal of thrombosis in AMI, CAG lumen stenosis <70.00%, and OCT of the offender lesion showed plaque rupture leading to AMI. For patients with a plaque rupture arc less than 90°, a ruptured plaque length less than 1mm, and no large free inner membrane, drug therapy can avoid stent implantation, reduce the occurrence of no reflux and stent restenosis after stent implantation.

Key words: Acute myocardial infarction, Optical coherence tomography, Percutaneous coronary intervention, Plaque rupture

Fangming Guo, Fanhui Yan, Yuanhang Liu, Yang Wang, Yanfen Zhang, Mingli Zhao, Yingjie Zhao, Mengmeng Liu, Jingdong Zhan. Application and therapeutic effect evaluation of optical coherence tomography in patients with acute myocardial infarction caused by plaque rupture[J]. Chinese Journal of Diagnostics(Electronic Edition), 2025, 13(01): 14-19.

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Figures/Tables 4

指标	入院时	12个月后	t值	P值
总胆固醇(mmol/l, $\overset{ˉ}{x}$ ±s)	5.11±0.89	2.61±0.60	26.53	＜0.01
低密度脂蛋白胆固醇(mmol/L, $\overset{ˉ}{x}$ ±s)	3.90±0.76	1.36±0.42	28.97	＜0.01
高密度脂蛋白胆固醇(mmol/L, $\overset{ˉ}{x}$ ±s)	1.02±0.22	1.07±0.23	16.35	＞0.05
甘油三酯(mmol/L, $\overset{ˉ}{x}$ ±s)	2.06±0.61	1.84±0.55	3.59	＜0.01
糖化血红蛋白(%, $\overset{ˉ}{x}$ ±s)	7.47±1.91	6.32±0.69	4.74	＜0.01
空腹血糖(mmol/L, $\overset{ˉ}{x}$ ±s)	8.19±2.62	6.02±1.08	6.56	＜0.01
肾小球滤过率[ml/(min·1.73m²), $\overset{ˉ}{x}$ ±s]	111.86±9.72	110.79±8.90	2.05	＞0.05

指标	入院时	12个月后	t值	P值
总胆固醇(mmol/l, $\overset{ˉ}{x}$ ±s)	5.11±0.89	2.61±0.60	26.53	＜0.01
低密度脂蛋白胆固醇(mmol/L, $\overset{ˉ}{x}$ ±s)	3.90±0.76	1.36±0.42	28.97	＜0.01
高密度脂蛋白胆固醇(mmol/L, $\overset{ˉ}{x}$ ±s)	1.02±0.22	1.07±0.23	16.35	＞0.05
甘油三酯(mmol/L, $\overset{ˉ}{x}$ ±s)	2.06±0.61	1.84±0.55	3.59	＜0.01
糖化血红蛋白(%, $\overset{ˉ}{x}$ ±s)	7.47±1.91	6.32±0.69	4.74	＜0.01
空腹血糖(mmol/L, $\overset{ˉ}{x}$ ±s)	8.19±2.62	6.02±1.08	6.56	＜0.01
肾小球滤过率[ml/(min·1.73m²), $\overset{ˉ}{x}$ ±s]	111.86±9.72	110.79±8.90	2.05	＞0.05

指标	基线时	12个月后	统计量	P值
最薄纤维帽厚度(μm, $\overset{ˉ}{x}$ ±s)	74.66±20.79	95.21±16.31	t=11.71	＜0.01
破裂斑块弧度(°, $\overset{ˉ}{x}$ ±s)	83.69±6.30	80.38±5.93	t=3.59	＜0.01
破裂斑块长度(mm, $\overset{ˉ}{x}$ ±s)	0.67±0.16	0.56±0.17	t=3.55	＜0.01
破裂斑块深度(μm, $\overset{ˉ}{x}$ ±s)	1410.34±214.40	1251.38±208.22	t=9.84	＜0.01
巨噬细胞浸润[例(%)]	20(68.97)	10(34.48)	χ ²=8.10	＜0.01
胆固醇结晶[例(%)]	16(55.17)	14(48.28)	χ ²=0.50	＞0.05
滋养血管[例(%)]	12(41.38)	10(34.48)	χ ²=0.50	＞0.05
最小管腔面积(mm², $\overset{ˉ}{x}$ ±s)	3.58±0.55	3.82±0.69	t=6.29	＜0.01
参考管腔面积(mm², $\overset{ˉ}{x}$ ±s)	8.20±1.75	8.24±1.73	t=1.58	＞0.05
面积狭窄率(%, $\overset{ˉ}{x}$ ±s)	64.00±4.26	61.79±4.23	t=3.51	＜0.01

指标	基线时	12个月后	统计量	P值
最薄纤维帽厚度(μm, $\overset{ˉ}{x}$ ±s)	74.66±20.79	95.21±16.31	t=11.71	＜0.01
破裂斑块弧度(°, $\overset{ˉ}{x}$ ±s)	83.69±6.30	80.38±5.93	t=3.59	＜0.01
破裂斑块长度(mm, $\overset{ˉ}{x}$ ±s)	0.67±0.16	0.56±0.17	t=3.55	＜0.01
破裂斑块深度(μm, $\overset{ˉ}{x}$ ±s)	1410.34±214.40	1251.38±208.22	t=9.84	＜0.01
巨噬细胞浸润[例(%)]	20(68.97)	10(34.48)	χ ²=8.10	＜0.01
胆固醇结晶[例(%)]	16(55.17)	14(48.28)	χ ²=0.50	＞0.05
滋养血管[例(%)]	12(41.38)	10(34.48)	χ ²=0.50	＞0.05
最小管腔面积(mm², $\overset{ˉ}{x}$ ±s)	3.58±0.55	3.82±0.69	t=6.29	＜0.01
参考管腔面积(mm², $\overset{ˉ}{x}$ ±s)	8.20±1.75	8.24±1.73	t=1.58	＞0.05
面积狭窄率(%, $\overset{ˉ}{x}$ ±s)	64.00±4.26	61.79±4.23	t=3.51	＜0.01

References 26

[1]	Sakakura K,Nakano M,Otsuka F,et al.Pathophysiology of atherosclerosis plaque progression[J]. Heart Lung Circ,2013,22(6):399-411.DOI:10.1016/j.hlc.2013.03.001.
[2]	Falk E,Nakano M,Bentzon JF,et al. Update on acute coronary syndromes:the pathologists' view[J].Eur Heart J,2013,34(10):719-728.DOI:10.1093/eurheartj/ehs411.
[3]	Ibánez B,James S,Agewall S,et al.2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation[J].Rev Esp Cardiol (Engl Ed),2017,70(12):1082.DOI:10.1016/j.rec.2017.11.010.
[4]	Kramer MC,Rittersma SZ,de Winter RJ,et al. Relationship of thrombus healing to underlying plaque morphology in sudden coronary death[J]. J Am Coll Cardiol,2010,55(2):122-132.DOI:10.1016/j.jacc.2009.09.007.
[5]	Jaffe R,Charron T,Puley G,et al. Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention[J].Circulation,2008,117(24):3152-3156. DOI:10. 1161/CIRCULATIONAHA.107.742312.
[6]	Harrison RW,Aggarwal A,Ou FS,et al.Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction [ J]. Am J Cardiol,2013(111):178-184. DOI:10. 1016/j. amjcard. 2012.09.015.
[7]	Annibali G,Scrocca I,Aranzulla TC,et al."No-Reflow" phenomenon:a contemporary review[J].J Clin Med,2022,11(8):2233. DOI:10.3390/jcm11082233.
[8]	Tasar O,Karabay AK,Oduncu V,et al.Predictors and outcomes of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention[J]. Coron Artery Dis,2019,30(4):270-276. DOI:10.1097/MCA.0000000000000726.
[9]	Niccoli G,Burzotta F, Galiuto L, et al. Myocardial no-reflow in humans[J]. J Am Coll Cardiol,2009,54(4):281-292. DOI:10.1016/j.jacc.2009.03.054.
[10]	de Waha S, Patel MR, Granger CB, et al. Relationship between microvascular obstruction and adverse events following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction:an individual patient data pooled analysis from seven randomized trials[J]. Eur Heart J,2017,38(47):3502-3510.DOI:10.1093/eurheartj/ehx414.
[11]	Fu Y,Gu XS,Hao GZ,et al.Comparison of myocardial microcirculatory perfusion after catheter-administered intracoronary thrombolysis with anisodamine versus standard thrombus aspiration in patients with ST-elevation myocardial infarction[J]. Catheter Cardiovasc Interv,2019,93(S1):839-845.DOI:10.1002/ccd.28112.
[12]	Writing Committee Members,Gulati M,Levy PD,et al.2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J]. J Cardiovasc Comput Tomogr,2022,16(1):54-122.DOI:10.1016/j.jcct.2021.11.009.
[13]	Bhatt DL, Lopes RD, Harrington RA. Diagnosis and treatment of acute coronary syndromes:a review[J]. JAMA,2022,327(7):662-675.DOI:10.1001/jama.2022.0358.
[14]	Bin N,Zhang F,Song X,et al.Thrombus aspiration during primary percutaneous coronary intervention improved outcome in patients with STEMI and a large thrombus burden[J].J Int Med Res,2021,49(5):3000605211012611.DOI:10.1177/03000605211012611.
[15]	Zhang Z, Sheng Z, Che W, et al. Design and rationale of the ATTRACTIVE trial: a randomised trial of intrAThrombus Thrombolysis versus aspiRAtion thrombeCTomy during prImary percutaneous coronary interVEntion in ST-segment elevation myocardial infarction patients with high thrombus burden[J].BMJ Open,2023,13(11):e076476. DOI:10. 1136/bmjopen-2023-076476.
[16]	Pelliccia F, Greco C, Tanzilli G, et al. Long-term outcome of patients with ST-segment elevation myocardial infarction treated with low-dose intracoronary thrombolysis during primary percutaneous coronary intervention:the 5-year results of the DISSOLUTION Trial[J].J Thromb Thrombolysis,2021,51(1):212-216. DOI:10. 1007/s11239-020-02157-w.
[17]	Prati F, Regar E, Mintz GS, et al. Expert review document on methodology, terminology, and clinical applications of optical coherence tomography:physical principles,methodology of image acquisition,and clinical application for assessment of coronary arteries and atherosclerosis[J]. Eur Heart J,2010,31(4):401-415.DOI:10.1093/eurheartj/ehp433.
[18]	Tearney GJ, Regar E, Akasaka T, et al. Consensus standards for acquisition,measurement,and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation[J]. J Am Coll Cardiol,2012,59(12):1058-1072.DOI:10.1016/j.jacc.2011.09.079.
[19]	Yahagi K,Zarpak R,Sakakura K,et al. Multiple simultaneous plaque erosion in 3 coronary arteries [J]. JACC Cardiovasc Imaging,2014,7(11):1172-1174. DOI:10. 1016/j. jcmg. 2014.08.005.
[20]	Vergallo R,Uemura S,Soeda T,et al.Prevalence and predictors of multiple coronary plaque ruptures: in vivo 3-vessel optical coherence tomography imaging study[J].Arterioscler Thromb Vasc Biol,2016,36(11):2229-2238. DOI:10. 1161/ATVBAHA.116.307891.
[21]	Tian J,Ren X,Vergallo R,et al.Distinct morphological features of ruptured culprit plaque for acute coronary events compared to those with silent rupture and thin-cap fibroatheroma:a combined optical coherence tomography and intravascular ultrasound study[J].J Am Coll Cardiol,2014,63(21):2209-2216. DOI:10. 1016/j. jacc.2014.01.061.
[22]	Fox KA,Dabbous OH,Goldberg RJ,et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome:prospective multinational observational study (GRACE)[J]. BMJ,2006,333(7578):1091. DOI:10.1136/bmj.38985.646481.55.
[23]	Loscalzo J.Nitric oxide insufficiency,platelet activation,and arterial thrombosis[J]. Circ Res,2001,88(8):756-762. DOI:10. 1161/hh0801.089861.
[24]	Libby P,Plutzky J. Diabetic macrovascular disease:the glucose paradox? [J]. Circulation,2002,106(22):2760-2763. DOI:10.1161/01.cir.0000037282.92395.ae.
[25]	Donkel SJ,Portilla Fernández E,Ahmad S,et al.Common and rare variants genetic association analysis of circulating neutrophil extracellular traps[J]. Front Immunol,2021(12):615527. DOI:10.3389/fimmu.2021.615527.
[26]	Beg F,Rehman H,Al-Mallah MH. The vulnerable plaque:recent advances in computed tomography imaging to identify the vulnerable patient[J]. Curr Atheroscler Rep,2020,22(10):58. DOI:10.1007/s11883-020-00879-z.

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