• Keisuke Satogami, Yasushi Ino, Takashi Kubo, Takashi Tanimoto, Makoto Orii, Yoshiki Matsuo, Shingo Ota, Tomoyuki Yamaguchi, Yasutsugu Shiono, Kunihiro Shimamura, Yosuke Katayama, Hiroshi Aoki, Tsuyoshi Nishiguchi, Yuichi Ozaki, Takashi Yamano, Takeyoshi Kameyama, Akio Kuroi, Hironori Kitabata, Atsushi Tanaka, Takeshi Hozumi, and Takashi Akasaka.
• Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
• JACC Cardiovasc Interv. 2017 May 22; 10 (10): 1025-1033.

ObjectivesThe aim of the present study was to investigate the association between plaque rupture (PR) assessed by optical coherence tomography (OCT), and the transmural extent of infarction (TEI) assessed by contrast-enhanced cardiac magnetic resonance imaging (CE-CMR) in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PCI).BackgroundPR is associated with larger infarct size as assessed by cardiac enzymes in STEMI patients. CE-CMR is a favorable method to assess TEI, which can predict the prognosis of STEMI patients.MethodsFirst, STEMI patients with primary PCI within 12 h after onset were enrolled and divided into 2 groups according to presence (n = 71) or absence (n = 32) of PR at the culprit lesion as assessed by pre-intervention OCT. CE-CMR was performed at 1 week after primary PCI.ResultsThe frequency of no-reflow phenomenon (37% vs. 16%; p = 0.032) and distal embolization (24% vs. 6%; p = 0.032) was significantly higher in the rupture group compared with the non-rupture group. TEI grade was significantly greater in the rupture group (28% vs. 15% in grade 3 and 45% vs. 13% in grade 4; p < 0.001). Microvascular obstruction was more frequently seen in the rupture group (39% vs. 19%; p = 0.039). Multivariate analysis identified PR (odds ratio: 6.60, 95% confidence interval: 2.19 to 21.69; p < 0.001) and no statin use before admission (odds ratio: 3.37, 95% confidence interval: 1.06 to 11.19; p = 0.039) as independent predictors of TEI grade 3 or 4.ConclusionsPR as assessed by OCT is associated with greater TEI as assessed by CE-CMR in STEMI patients after primary PCI.Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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