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Optical coherence tomography predicts no-reflow after PCI in NSTEACS
1 July 2009
MedWire News: Pre-intervention optical coherence tomography (OCT) can predict no-reflow and impaired microcirculation after percutaneous corornary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS), a Japanese study has found.
Lipid content from culprit plaque may play a key role in damage to microcirculation following PCI for NSTEACS, note Atsushi Tanaka and team from Wakayama Medical University.
Myocardial no-reflow may be associated with poor outcomes following PCI for NSTEACS, but no previous study has identified a method for accurately predicting no-reflow in NSTEACS prior to PCI.
The researchers investigated 83 consecutive patients with NSTEACS who underwent OCT and successful emergent primary stenting. On the basis of post-stent thrombosis in myocardial infarction (TIMI) flow, patients were divided into a no-reflow group (n=14) and a reflow group (n=69).
Thin-cap fibroatheroma (TCFA) was defined as a plaque presenting lipid content for over 90°, and with the thinnest part of the fibrous cap measuring less than 70 µm. TCFAs were observed significantly more frequently in the no-reflow group than in the reflow group (50% vs 16%).
The frequency of the no-reflow phenomenon increased as the degree of the lipid arc in the culprit plaque increased. Final TIMI blush grade also deteriorated according to the increase in the lipid arc. A multivariable logistic regression model revealed that lipid arc alone was an independent predictor of no-reflow, at an odds ratio of 1.018.
Writing in the European Heart Journal, the researchers comment: “We believe that OCT can be used in the setting of NSTEACS for the evaluation of the lesion, to determine which lesion is suitable for early PCI, conducted while taking advantage of techniques for distal protection for preventing the no-reflow phenomenon.”
They conclude: “Our results suggest OCT is a useful coronary imaging modality for stratifying risk for early PCI in NSTEACS.
