Abstract 17627: Plaque Erosion, Compared to Plaque Rupture, is Associated With Better Outcomes After Primary Percutaneous Coronary Intervention in Patients With ST-segment Elevation Myocardial Infarction
Background: Acute coronary syndromes are caused not only by plaque rupture but also by other mechanisms such as plaque erosion or calcified nodule. The aim of the current study was to investigate the morphological characteristics of the culprit lesion and correlate them with outcomes in patients with STEMI undergoing primary PCI.
Methods and Results: Ninety-four patients with STEMI who underwent OCT during the acute phase were included in this study. In patients with initial TIMI flow grade <2, aspiration thrombectomy was performed before OCT imaging. Underlying plaque characteristics were compared with post-PCI reperfusion grade and degree of myocardial damage.
The prevalence of plaque rupture, plaque erosion, and calcified nodule was 56.4%, 39.4%, and 4.3%, respectively. Although initial TIMI flow grade did not differ between the 2 groups, final TIMI flow grade (2.95±0.48 vs. 2.77±0.47, p=0.040) and final myocardial blush grade (2.38±0.92 vs. 1.96±0.90, p=0.035) were significantly higher in plaque erosion than in rupture. The peak creatine phosphokinase level was significantly lower in plaque erosion than in rupture (2096 IU/L [IQR: 1026-4645] vs. 3140 [IQR: 2123-5492] IU/L, p=0.016).
Conclusions: STEMI caused by plaque erosion, compared to rupture, is associated with better final reperfusion grade and smaller myocardial damage after primary PCI.
Author Disclosures: T. Higuma: None. T. Soeda: None. N. Abe: None. M. Yamada: None. H. Yokoyama: None. S. Shibutani: None. K. Izumiyama: None. F. Nishizaki: None. T. Osanai: None. I. Jang: None. K. Okumura: None.
- © 2014 by American Heart Association, Inc.