Abstract
BackgroundPrevious studies reported the cardiac protection effect of preinfarction angina (PIA) in patients with acute myocardial infarction (AMI). We sought to identify culprit-plaque morphology and clinical outcomes associated with PIA in patients with ST-segment elevation myocardial infarction (STEMI) using optical coherence tomography (OCT).Methods and ResultsA total of 279 patients with STEMI between March 2017 and March 2019 who underwent intravascular OCT of the culprit lesion were prospectively included. Of them, 153 (54.8%) patients were presented with PIA. No differences were observed in clinical and angiographic data between the two groups, except STEMI onset with exertion was significantly less common in the PIA group (24.2 vs. 40.5%, p = 0.004). Patients with PIA exhibited a significantly lower incidence of plaque rupture (40.5 vs. 61.9%, p < 0.001) and lipid-rich plaques (48.4 vs. 69.0%, p = 0.001). The thin-cap fibroatheroma (TCFA) prevalence was lower in the PIA group, presenting a thicker fibrous cap thickness, although statistically significant differences were not observed (20.3 vs. 30.2%, p = 0.070; 129.1 ± 92.0 vs. 111.4 ± 78.1 μm, p = 0.088; respectively). The multivariate logistic regression analysis indicated that PIA was an independent negative predictor of plaque rupture (odds ratio: 0.44, 95% CI: 0.268–0.725, p = 0.001). No significant differences in clinical outcomes were observed besides unplanned revascularization.ConclusionCompared with the non-PIA group, STEMI patients with PIA showed a significantly lower prevalence of plaque rupture and lipid-rich plaques in culprit lesion, implying different mechanisms of STEMI attack in these two groups.
Highlights
Preinfarction angina (PIA), manifesting as an episode of angina before the onset of acute myocardial infarction (AMI), plays crucial roles in limiting reperfusion time, restricting infarct size, improving cardiac function, and reducing mortality [1,2,3,4]
We defined the narrow meaning of PIA as at least two episodes of typical chest pain or referred pain that persists for 3–30 min within 1 week prior to the onset of myocardial infarction [12, 13]
155 patients who underwent Optical coherence tomography (OCT) were excluded for the following reasons: lack of preintervention OCT images (n = 8), poor imaging quality due to massive thrombus (n = 83), in-stent restenosis (n = 34), coronary spasm (n = 11), coronary embolism
Summary
Preinfarction angina (PIA), manifesting as an episode of angina before the onset of acute myocardial infarction (AMI), plays crucial roles in limiting reperfusion time, restricting infarct size, improving cardiac function, and reducing mortality [1,2,3,4]. The association between PIA and culprit plaque characteristics in patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. Optical coherence tomography (OCT) with a resolution of 10–20 μm is superior to other intravascular imaging technologies with respect to the accurate evaluation of plaque morphology and vulnerability in patients with the acute coronary syndrome (ACS) in vivo [7]. This study identifies specific morphological characteristics of culprit plaques associated with PIA in patients with STEMI using OCT. Previous studies reported the cardiac protection effect of preinfarction angina (PIA) in patients with acute myocardial infarction (AMI). We sought to identify culprit-plaque morphology and clinical outcomes associated with PIA in patients with ST-segment elevation myocardial infarction (STEMI) using optical coherence tomography (OCT)
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