OCT-Based Diagnosis and Management of STEMI Associated With Intact Fibrous Cap
THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION. PUBLISHED BY ELSEVIER INC.
AUTHORS: Francesco Prati, MD, PHD, Shiro Uemura, MD, PHD
Geraud Souteyrand, MD, PHD Renu Virmani, MD,
Pascal Motreff, MD, PHD, Luca Di Vito, MD, PHD
Giuseppe Biondi-Zoccai, MD, PHD, Jonathan Halperin, MD
Valentin Fuster, MD, PHD, Yukio Ozaki, MD, PHD
Jagat Narula, MD, PHD
In autopsy studies, at least 25% of thrombotic coronary occlusions are caused by plaque erosion in which thrombus often overlies atherosclerotic plaque without evident disruption of the fibrous cap. We per- formed optical coherence tomography imaging after aspiration thrombectomy and identified plaque erosion as the cause in 31 patients presenting with ST-segment elevation myocardial infarction. Plaque erosion was identified when the fibrous cap of the culprit lesion was intact. Based on clinical criteria, 40% of patients with subcritically occlusive plaque were treated with dual antiplatelet therapy without percu- taneous revascularization (group 1), and the remaining 60% of patients underwent angioplasty and stenting (group 2). At a median follow-up of 753 days, all patients were asymptomatic, regardless of stent implantation. These observations support an alternative treatment strategy for patients with acute coro- nary events and optical coherence tomography–verified intact fibrous cap (or plaque erosion), where nonobstructive lesions might be managed without stenting. (J Am Coll Cardiol Img 2013;6:283–7) © 2013 by the American College of Cardiology Foundation.