Abstract：
Microvascular reperfusion following percutaneous coronary intervention (PCI) is associated with the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). We investigated how plaque characteristics detected by optical coherence tomography (OCT) in STEMI patients affect the status of the microcirculation during PCI.Methods and Results: This retrospective, single-center study was a post hoc analysis basedon the multicenter SALVAGE randomized control trial (NCT03581513) that enrolled 629 STEMI patients, and finally we enrolled 235 patients who underwent PCI and pre-intervention OCT. Microvascular perfusion was evaluated using the Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion frame count (TMPFC). Patients were divided into 3 groups based on the change in TMPFC from before to after PCI: improving TMPFC (n=11; 4.7%), stable TMPFC (n=182; 77.4%), and worsening TMPFC group (n=42; 17.9%). The proportion of patients with a microcirculation dysfunction before reperfusion was 11.9%, which increased significantly by (P=0.079) 8.5% to 20.4% after reperfusion. Compared with plaque characteristics in the stable and worsening TMPFC groups, the improving TMPFC group had fewer thrombi (90.7% and 90.5% vs. 89.4%, respectively; P=0.018), a lower proportion of plaque rupture (66.5% and 66.3% vs. 54.5%, respectively; P=0.029), and a lower proportion of lipid-rich plaques (89.6% and 88.1% vs. 63.6%, respectively; P=0.036).
PCI may not always achieve complete myocardial reperfusion. Thrombi, plaque rupture, and lipid-rich plaques detected by OCT can indicate microcirculation dysfunction during the reperfusion period.
PCI may not always achieve complete myocardial reperfusion. Thrombi, plaque rupture, and lipid-rich plaques detected by OCT can indicate microcirculation dysfunction during the reperfusion period.
摘要：
背景：经皮冠状动脉介入治疗（PCI）后的微血管再灌注与ST段抬高型心肌梗死（STEMI）患者的预后相关。我们调查了STEMI患者光学相干断层扫描（OCT）检测到的斑块特征如何影响PCI期间的微循环状态。方法和结果：本研究回顾性，单中心研究是一项基于多中心SALVAGE随机对照试验（NCT03581513）的事后分析，该试验纳入629例STEMI患者，最后,我们纳入了235例接受PCI和干预前OCT的患者.使用心肌梗死溶栓（TIMI）心肌灌注帧计数（TMPFC）评估微血管灌注。根据PCI前后TMPFC的变化将患者分为3组：改善TMPFC（n=11;4.7％），稳定的TMPFC（n=182；77.4%），TMPFC组恶化（n=42；17.9%）。再灌注前出现微循环功能障碍的患者比例为11.9%,再灌注后显着增加（P=0.079）8.5％至20.4％。与稳定和恶化的TMPFC组的斑块特征相比，改善的TMPFC组有较少的血栓(90.7%和90.5%vs.89.4%,分别为；P=0.018)，斑块破裂比例较低(66.5%和66.3%vs.54.5%,分别为；P=0.029)，和较低比例的富含脂质的斑块(89.6%和88.1%vs.63.6%,分别；P=0.036)。
结论：PCI可能并不总是实现完全的心肌再灌注。血栓,斑块破裂,通过OCT检测到的富含脂质的斑块可以指示再灌注期的微循环功能障碍。
结论：PCI可能并不总是实现完全的心肌再灌注。血栓,斑块破裂,通过OCT检测到的富含脂质的斑块可以指示再灌注期的微循环功能障碍。
