A contemporary re-evaluation of culprit lesion severity in patients presenting with STEMI.

Liam M McCormick, Stephen P Hoole, Adam J Brown, David P Dutka, Nick E J West
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引用次数: 8

Abstract

Background: Historical data report fatal myocardial infarction occurring when mildly-stenotic coronary plaques rupture; however, recent data suggest haemodynamically-significant coronary stenoses with fractional flow reserve (FFR) ≤ 0.8 and vessels with high plaque burden and minimum luminal area (MLA) < 4 mm(2) by intravascular ultrasound (IVUS) may be prognostically important. Therefore, we sought to re-evaluate culprit stenosis severity in patients presenting with ST-segment elevation myocardial infarction (STEMI).

Methods: Patients undergoing primary percutaneous coronary intervention (PPCI) for STEMI with adjunctive thrombectomy between October 2008 and February 2010 (n = 336/572; 59%) underwent quantitative coronary angiography (QCA) after thrombus aspiration to determine vessel reference area (RA), MLA and percentage area stenosis (AS). To validate findings, QCA and FFR were measured in 50 patients with stable angina and an angiographically-intermediate lesion.

Results: STEMI patients had anatomically-severe underlying culprit disease similar to that of the stable cohort (AS: 91.6 ± 9.5% versus 90.1 ± 8.1%; P = 0.11). Additionally, anatomically-severe lesions defined by QCA were more likely to be functionally-significant by FFR and vice-versa (P = 0.02 and 0.002 respectively).

Conclusion: These contemporary data suggest that STEMI culprit lesions, defined by luminal stenosis after thrombus aspiration, are angiographically significant, with similar stenosis severity to stable, ischaemia-inducing lesions.

当代STEMI患者罪魁祸首病变严重程度的重新评估。
背景:历史资料报道当轻度狭窄的冠状动脉斑块破裂时发生致死性心肌梗死;然而,最近的数据表明,血流储备分数(FFR)≤0.8、高斑块负担和最小管腔面积(MLA) < 4mm(2)的血管内超声(IVUS)具有血流动力学意义的冠状动脉狭窄可能对预后有重要影响。因此,我们试图重新评估st段抬高型心肌梗死(STEMI)患者的罪魁祸首狭窄严重程度。方法:2008年10月至2010年2月间接受原发性经皮冠状动脉介入治疗(PPCI)并辅助取栓的STEMI患者(n = 336/572;59%)在血栓抽吸后行定量冠状动脉造影(QCA),以确定血管参考面积(RA)、MLA和面积狭窄百分比(AS)。为了验证结果,我们测量了50例稳定型心绞痛和血管造影中度病变患者的QCA和FFR。结果:STEMI患者有解剖学上严重的潜在罪魁祸首疾病,与稳定组相似(AS: 91.6±9.5% vs 90.1±8.1%;P = 0.11)。此外,QCA定义的解剖严重病变更有可能在FFR中具有功能显著性,反之亦然(P分别= 0.02和0.002)。结论:这些当代数据表明,STEMI罪魁祸首病变(由血栓吸入后的管腔狭窄定义)在血管造影上是显著的,其狭窄程度与稳定的缺血诱导病变相似。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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