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Impact of optical coherence tomography findings on clinical outcomes in ST-segment elevation myocardial infarction patients: a MATRIX (Minimizing Adverse Hemorrhagic Events by Trans-radial Access Site and angioX) OCT sub-study

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Abstract

Purpose

To investigate the association of the degree of stent expansion, as assessed by optical coherence tomography (OCT), following stent implantation, and clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients.

Methods

STEMI patients from the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and angioX) OCT study were selected; Clinical outcomes were collected through 1 year. Stent expansion index is a minimum stent area (MSA) divided by average lumen area (average of proximal and distal reference lumen area). The following variables were measured: MSA (< 4.5mm2), dissection (> 200 µm in width and < 5 mm from stent segment), malapposition (> 200 µm distance of stent from vessel wall), a thrombus (area > 5% of lumen area) were compared.

Results

A total of 151 patients were included; after excluding patients with suboptimal OCT quality, the population with available OCT was classified into 2 groups: under–expanded < 90% (N = 72, 51%) and well–expanded ≥ 90% (N = 67, 49%). In the well–expanded group, a significant number of the proximal vessels had a lumen area < 4.5mm2 (16.1%, p < 0.001) and a greater thrombus burden within stent (56.7%, p = 0.042). The overall 30 day and 1 year major adverse cardiovascular event (MACE) rates were 5% and 6.1%, respectively.

Conclusion

Irrespective of the degree of stent expansion, the OCT findings, in STEMI patients, and the MACE at 30 days and one year follow up was low; further, well–expanded stents led to a more significant residual thrombotic burden within the stent but seemed to have insignificant clinical impact. Acknowledged stent optimization criteria, traditionally related to worse outcomes in stable patients, do not seem to be associated with worse outcomes in this STEMI population.

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Abbreviations

ACS:

Acute coronary syndrome

MACE:

Major adverse cardiovascular event

MLA:

Minimum lumen area

MSA:

Minimum stent area

NSTEMI:

Non-ST segment elevation myocardial infarction

OCT:

Optical coherence tomography

PCI:

Percutaneous coronary intervention

PPCI:

Primary percutaneous coronary intervention

STEMI:

ST segment elevation myocardial infarction

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Acknowledgement

None

Funding

Dr. Varbella reports personal fees from chiesi, personal fees from bayer, personal fees from astrazeneca, personal fees from daichisankyo, personal fees from boeringher, personal fees from pfizer BMS, personal fees from menarini, personal fees from servier, personal fees from Alvimedica CID, personal fees from Stentys, personal fees from Abbott vascular, grants from Sanitex, grants from Biotronik, outside the submitted work. Dr. Ando’ reports non-financial support from Terumo, during the conduct of the study; personal fees from Daiichi-Sankyo, personal fees and non-financial support from Bayer, personal fees from Pfizer-BMS, non-financial support from Boeringer-Ingelheim, personal fees from AstraZeneca, personal fees and non-financial support from Menarini, non-financial support from Abbott, non-financial support from Philips Volcano, non-financial support from Boston Scientific, outside the submitted work. Dr. Valgimigli reports grants from Medtronic, personal fees from Abbott, personal fees from Chiesi, personal fees from Bayer, personal fees from Servier, personal fees from Boeringher, personal fees from Daiichi Sankyo, outside the submitted work;

Author information

Authors and Affiliations

  1. MedStar Washington Hospital Center, Washington, DC, USA

    Omar Yacob, Hector M. Garcia-Garcia, Kazuhiro Dan & Kayode O. Kuku

  2. Rutgers New Jersey Medical School, Newark, NJ, USA

    Mohamad Soud

  3. Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardio-Thoracic Department, University of Brescia, Brescia, Italy

    Marianna Adamo

  4. Cardiovascular and Neurologic Department, Misericordia Hospital, Grosseto, Italy

    Andrea Picchi & Ugo Limbruno

  5. Department of Cardiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy

    Gennaro Sardella

  6. Clinical Trials Unit, University of Bern, Bern, Switzerland

    Enrico Frigoli & Alexios Karagiannis

  7. Division of Cardiology, Sant’Andrea Hospital, Rome, Italy

    Stefano Rigattieri

  8. Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands

    Roberto Diletti

  9. Department of Cardiology, S.G. Bosco Hospital, Torino, Italy

    Giacomo Boccuzzi

  10. Institute of Cardiology “G. D’Annunzio” University, Chieti, Italy

    Marco Zimarino

  11. Interventional Cardiology Unit Umberto I Hospital, Syracuse, Italy

    Marco Contarini

  12. Interventional Cardiology Unit, Cardio-thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy

    Filippo Russo

  13. Division of Cardiology, Department of Cardiothoracic and Respiratory Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Paolo Calabro

  14. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Giuseppe Ando

  15. Cardiology Unit, Ospedali Riuniti Di Rivoli, Turin, Italy

    Ferdinando Varbella

  16. Unita’ Operativa Complessa Di Cardiologia ASST Di Vimercate (MB), Vimercate, Italy

    Stefano Garducci

  17. Fondazione Toscana G. Monasterio—Ospedale del Cuore G. Pasquinucci, Pisa/Massa, Italy

    Cataldo Palmieri

  18. Department of Cardiology, Clinica Mediterranea, Napoli, Italy

    Carlo Briguori

  19. Swiss Cardiovascular Center, University of Bern, Bern, Switzerland

    Marco Valgimigli

Authors
  1. Omar Yacob
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  2. Hector M. Garcia-Garcia
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  3. Kazuhiro Dan
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  4. Mohamad Soud
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  5. Marianna Adamo
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  6. Andrea Picchi
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  7. Gennaro Sardella
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  8. Enrico Frigoli
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  9. Ugo Limbruno
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  10. Stefano Rigattieri
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  11. Roberto Diletti
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  12. Giacomo Boccuzzi
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  13. Marco Zimarino
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  14. Marco Contarini
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  15. Filippo Russo
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  16. Paolo Calabro
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  17. Giuseppe Ando
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  18. Ferdinando Varbella
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  19. Stefano Garducci
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  20. Cataldo Palmieri
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  21. Carlo Briguori
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  22. Kayode O. Kuku
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  23. Alexios Karagiannis
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  24. Marco Valgimigli
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Corresponding authors

Correspondence to Hector M. Garcia-Garcia or Marco Valgimigli.

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Yacob, O., Garcia-Garcia, H.M., Dan, K. et al. Impact of optical coherence tomography findings on clinical outcomes in ST-segment elevation myocardial infarction patients: a MATRIX (Minimizing Adverse Hemorrhagic Events by Trans-radial Access Site and angioX) OCT sub-study. Int J Cardiovasc Imaging 37, 1143–1150 (2021). https://doi.org/10.1007/s10554-020-02098-8

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