Optical coherence tomography, delayed stent implantation and primary percutaneous coronary intervention in patients with myocardial infarction and ST segment elevation

Czech version

Authors: Pavel Červinka ^1,2,3
Authors‘ workplace: I. interní kardioangiologická klinika LF UK a FN Hradec Králové, přednosta prof. MUDr. Pavel Červinka, Ph. D. ¹; Kardiologická klinika Masarykovy nemocnice v Ústí nad Labem, Krajská zdravotní, a. s., přednosta prof. MUDr. Pavel Červinka, Ph. D. ²; Fakulta zdravotnických studií UJEP Ústí nad Labem, děkan doc. MUDr. Miroslav Tichý, CSc. ³
Published in: Vnitř Lék 2014; 60(4): 293-297
Category: 60th Birthday - prof. MUDr. Petr Widimský, DrSc., FESC, FACC

Overview

Primary percutaneous coronary intervention (PCI) is an effective treatment for myocardial infarction with ST-segment elevation. However, the stent may slow (slow-flow) or even interrupt the flow (no-reflow) in the infarct-related artery with an increase in short-term and long-term mortality. Due to these limitations there is an effort to search for alternative methods or certain modifications of existing PCI. Present article introduces a modified PCI and results of trombo-aspiration technique by optical coherence tomography (OCT). The article presents the results of our clinical study and brief case report. Our pilot project involved 100 patients with STEMI in 2011–2012. 20 patients (20%) were initially treated only with trombo-aspiration without stent implantation, based on OCT. Control angiography and OCT done 9 months after event have revealed insignificant stenosis in all patients. It is plausible that universal medical procedure with stenting is not suitable for all patients with STEMI and especially patients with large thrombus may benefit from the alternative procedure performed by manually trombo-aspiration technique with intensive anticoagulant/antiaggregant therapy. Nevertheless, only randomized trials with sufficiently follow-up may confirm this hypothesis.

Key words:
delayed stent implantation –⁠ optical coherence tomography –⁠ primary percutaneous coronary intervention –⁠ trombo-aspiration

Sources

1. Andersen HR, Nielsen TT, Vesterlund T et al. Danish multicenter randomized study on fibrinolytic therapy versus acute coronary angioplasty in acute myocardial infarction: rationale and design of the DANish trial in Acute Myocardial Infarction-2 (DANAMI-2). Am Heart J 2003; 146(2): 234–241.

2. Widimsky P, Budesinsky T, Vorac D et al. Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction. Final results of the randomized national multicentre trial -⁠ PRAGUE-2. Eur Heart J 2003; 24(1): 94–104.

3. Sianos G, Papafaklis MI, Daemen J et al. Angiographic stent thrombosis after routine use of drug eluting stents in ST-segment myocardial infarction: the importance of thrombus burden. J Am Coll Cardiol 2007; 50(7): 573–583.

4. Steg PG, Fox KAA, Eagle KA et al. Mortality following placement of drug-eluting and bare-metal stents for ST-segment elevation acute myocardial infarction in the Global Registry of Acute Coronary Events. Eur Heart J 2009; 30(3): 321–329.

5. Brosh D, Assali AR, Mager A et al. Effect of no-reflow during primary percutaneous coronary intervention for acute myocardial infarction on six-month mortality. Am J Cardiol 2007; 99(4): 442–445.

6. Ndrepepa G, Tiroch K, Fusaro M et al. 5-Year prognostic value of no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction. J Am Coll Cardiol 2010; 55(21): 2383–2389.

7. DeWood MA, Spores J, Notske R et al. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med 1980; 303(16): 897–902.

8. Virmani R, Kolodgie FD, Burke AP et al. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 2000; 20(5): 1262–1275.

9. Burke AP, Farb A, Malcom GT et al. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med 1997; 336(18): 1276–1282.

10. Davies MJ, Thomas A. Thrombosis and acute coronary artery lesions in suddencardiac ischemic death. N Engl J Med 1984; 310(18): 1137–1140.

11. Fuster V, Badimon L, Badimon JJ et al. The pathogenesis of coronary artery disease and the acute coronary syndromes (1). N Eng J Med 1992; 326(4): 242–250. 11a. Fuster V, Badimon L, Badimon JJ et al. The pathogenesis of coronary artery disease and the acute coronary syndromes (2). N Eng J Med 1992; 326(5): 310–318.

12. Meneveau N, Seronde MF, Descontes-Genon V et al. Immediate versus delayed angioplasty in infarct-related arteries with TIMI III flow and ST segment recovery: a matched comparison in acute myocardial infarction patients. Clin Res Cardiol 2009; 98(4): 257–264.

13. Svilaas T, Vlaar PJ, van der Horst IC et al. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med 2008; 358(6): 557–567.

14. Freixa X, Belle L, Joseph L et al. Immediate vs. delayed stenting in acute myocardial infarction: a systematic review and meta-analysis. EuroIntervention 2013; 8(10): 1207–1216.

15. Jolicoeur EM, Tanguay JF From primary to secondary percutaneous coronary intervention: The emerging concept of early mechanical reperfusion with delayed facilitated stenting-when earlier may not be better. Can J Cardiol 2011; 27(5): 529–533.

16. Červinka P, Špaček R, Bystroň M et al. Optical Coherence Tomography-Guided Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients: A Pilot Study. Can J Cardiol 2014; 30(4): 420–427.

17. Kubo T, Akasaka T Recent advances in intracoronary imaging techniques: focus on optical coherence tomography. Expert Rev Med Devices 2008; 5(6): 691–697.

18. Kume T, Akasaka T, Kawamoto T et al. Measurement of the thickness of the fibrous cap by optical coherence tomography. Am Heart J 2006; 152(4): 755 e1-e4.