P3591Residual atherothrombotic burden after primary percutaneous coronary intervention and myocardial reperfusion - An optical frequency domain imaging study

• Published in: European heart journal Vol. 40; no. Supplement_1
• Main Authors: Roule, V, Schwob, L, Lemaitre, A, Bignon, M, Ardouin, P, Sabatier, R, Blanchart, K, Beygui, F
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01-10-2019
• Subjects: Acute Coronary Syndromes: Angiography, Invasive Imaging, FFR
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz745.0451

Abstract
Background
The clinical significance of residual in-stent atherothrombotic burden (ATB) after primary percutaneous coronary intervention (PCI) remains unclear. Several methods of ATB quantification using optical frequency domain imaging (OFDI) exist.
Objectives
We aimed to assess the relationship between residual ATB after primary PCI measured in OFDI using different methods and myocardial blush grade (MBG).
Methods
We prospectively included 60 ST-elevation myocardial infarction patients pre-treated with aspirin and ticagrelor. OFDI volumetric quantification using planimetry (with intervals every frame or every millimeter) and semi-quantitative score were used to determine ATB. Patients were divided into two groups according to final MBG 3 or <3.
Results
MBG 3 was identified in 28 (46%) patients. Altogether, 13318 OFDI cross-sections were analyzed. The mean ATB was 10.08±5.21%. ATB was lower in patients with normal final MBG compared to those with impaired MBG, regardless of the method used (8.15±5.58 vs 11.77±4.28%; p=0.007 for quantification per frame; 7.8±5.19 vs 11.07±4.07%; p=0.009 for quantification per mm and 11.21±11.75 vs 22.91±17.35; p=0.003 for the semi-quantitative thrombus score, respectively).
Table 1. Post stenting OFDI findings
OFDI measures
All
Final Blush <3
Final Blush 3
p
n=60 (100%)
n=32 (53%)
n=28 (47%)
Stent volume (mm3)
219.42±135.76
226.08±168.69
211.82±86.57
0.68
Evaluation per frame
  Atherothrombotic volume (mm3)
21.66±16.81
25.83±18.86
16.89±12.83
0.035
  Atherothrombotic burden (%)
10.08±5.21
11.77±4.28
8.15±5.58
0.007
Evaluation per millimeter
  Atherothrombotic volume (mm3)
20.71±16.16
24.57±18.15
16.29±12.43
0.042
  Atherothrombotic burden (%)
9.5±4.88
11.07±4.07
7.8±5.19
0.009
Thrombus score
17.45±16
22.91±17.35
11.21±11.75
0.003
Optical frequency domain imaging example
Conclusion
Residual post-stenting ATB remains substantial after primary PCI in STEMI patients, even when pre-treated with ticagrelor and aspirin. Mostly, it appears as an important surrogate of clinical outcome as patients with normal myocardial reperfusion presented lower residual ATB.