Difference of Culprit Lesion Morphologies Between ST-Segment Elevation Myocardial Infarction and Non–ST-Segment Elevation Acute Coronary Syndrome

Ino, Yasushi; Kubo, Takashi; Tanaka, Atsushi; Kuroi, Akio; Tsujioka, Hiroto; Ikejima, Hideyuki; Okouchi, Keishi; Kashiwagi, Manabu; Takarada, Shigeho; Kitabata, Hironori; Tanimoto, Takashi; Komukai, Kenichi; Ishibashi, Keiichiro; Kimura, Keizo; Hirata, Kumiko; Mizukoshi, Masato; Imanishi, Toshio; Akasaka, Takashi

doi:10.1016/j.jcin.2010.09.022

Cited by 179 publications

(82 citation statements)

References 26 publications

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“…The incidences of plaque rupture (70% versus 47%), thin-cap fibroatheroma (78% versus 49%), and red thrombus (78% versus 49%) were significantly higher in STEMI, compared to NSTEMI patients, and they had a larger ruptured cavity area than NSTEMI patients. 23) Therefore, as damages by infarct transmurality are not relatively serious in NSTEMI compared to STEMI, postinterventional coronary flow could have less influences on overall survival benefit. And, there is a potential for early hazard due to intervention on unstable plaques with fresh thrombus.…”

Section: Discussionmentioning

confidence: 99%

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

et al. 2017

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SummaryThis study aimed to evaluate the clinical prognostic implications of postprocedural Thrombolysis in Myocardial Infarction (TIMI) flow in acute myocardial infarction patients. A total of 2796 ST-elevation myocardial infarction (STEMI) and 1720 non ST-elevation myocardial infarction (NSTEMI) patients treated in 8 hospitals affiliated with the Catholic University of Korea and Chonnam National University Hospital were analyzed. The study populations were divided according to the final TIMI flow. The primary outcome were the major adverse cardiac events (MACE), defined as a composite of cardiac deaths (CD), nonfatal myocardial infarctions (MI), and target lesion revascularization (TLR). Over a median follow-up of 3.3 years (minimum 2 to maximum 5 years), MACE and CD occurred more frequently in STEMI patients with TIMI !2 group than those with TIMI 3 (MACE: adjusted hazard ratio [aHR], 1.962; 95% confidence interval [CI] 1.513 to 2.546, P < 0.001, CD: aHR, 3.154, CI 2.308 to 4.309, P < 0.001). However, there was no significant difference between the two subgroups in NSTEMI (aHR, 0.932; 95% CI 0.586 to 1.484, P = 0.087). In STEMI patients, good postprocedural TIMI flow after PCI was associated with favorable clinical outcomes. And the effect of poor TIMI flow in STEMI was on death, not the components of MACE. Meanwhile, postprocedural TIMI flow had no effect on long-term outcomes in NSTEMI patients.(Int Heart J 2017; 58: 674-685)

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Section: Discussionmentioning

confidence: 99%

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

et al. 2017

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“…22 Moreover, plaque rupture was more frequent in STEMI patients than in NSTE-ACS (70% vs. 47%, P=0.033), and cap disruption tended to be directed against the coronary flow in STEMI patients. 25 Fibrous cap thickness is one of the most critical determinants of plaque rupture susceptibility. 12 The widely accepted cut-off point for rupture-prone plaque, 65 μm, was obtained from a pathological study 34 in which the thinnest fibrous cap thickness was measured in 41 ruptured plaques causing sudden cardiac death (95th percentile value, 65 μm).…”

Section: Advances In Imaging Speedmentioning

confidence: 99%

Optical Coherence Tomography

Yonetsu

Bouma

Katô

et al. 2013

Circ J

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Since its invention in the late 1990 s, intravascular optical coherence tomography (OCT) has been rapidly adopted in clinical research and, more recently, in clinical practice. Given its unprecedented resolution and high image contrast, OCT has been used to visualize plaque characteristics and to evaluate the vascular response to percutaneous coronary intervention. In particular, OCT is becoming the standard modality to evaluate in vivo plaque vulnerability, including the presence of lipid content, thin fibrous cap, or macrophage accumulation. Furthermore, OCT findings after stent implantation, such as strut apposition, neointimal hyperplasia, strut coverage, and neoatherosclerosis, are used as surrogate markers of the vascular response. New applications for OCT are being explored, such as transplant vasculopathy or non-coronary vascular imaging. Although OCT has contributed to cardiovascular research by providing a better understanding of the pathophysiology of coronary artery disease, data linking the images and clinical outcomes are lacking. Prospective data are needed to prove that the use of OCT improves patient outcomes, which is the ultimate goal of any clinical diagnostic tool. (Circ J 2013; 77: 1933 -1940

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“…In line with the latter interpretation, total cholesterol and LDL values were significantly lower in patients with UA, as compared with STEMI and NSTEMI. Of note, optical coherence tomography (OCT) studies have shown that STEMI patients have larger cavities than those with NSTEMI [19]. A previously published study from the GRACE has also demonstrated that preventive cardiovascular premedication can influence the type of ACS presentation [20] and therefore might modulate clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Current outcome of acute coronary syndromes: data from the Zurich-Acute Coronary Syndrome (Z-ACS)-Registry

2013

Cardiovasc Med

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Difference of Culprit Lesion Morphologies Between ST-Segment Elevation Myocardial Infarction and Non–ST-Segment Elevation Acute Coronary Syndrome

Abstract: The present OCT study demonstrated the differences of the culprit lesion morphologies between STEMI and NSTEACS. The morphological feature of plaque rupture and the intracoronary thrombus could relate to the clinical presentation in patients with acute coronary disease.

Cited by 179 publications

References 26 publications

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction

Optical Coherence Tomography

Current outcome of acute coronary syndromes: data from the Zurich-Acute Coronary Syndrome (Z-ACS)-Registry

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