Systemic and local factors associated with reduced thrombolysis in myocardial infarction flow in ST-segment elevation my
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ORIGINAL PAPER
Systemic and local factors associated with reduced thrombolysis in myocardial infarction flow in ST‑segment elevation myocardial infarction patients with plaque erosion detected by intravascular optical coherence tomography Jifei Wang1 · Chao Fang1 · Shaotao Zhang1 · Lulu Li1 · Jia Lu1 · Yidan Wang1 · Yini Wang1 · Huai Yu1 · Guo Wei1 · Yanwei Yin1 · Senqing Jiang1 · Junchen Guo1 · Fangmeng Lei1 · Huimin Liu1 · Maoen Xu1 · Xuefeng Ren1 · Lijia Ma1 · Yingfeng Tu1 · Lei Xing1 · Jingbo Hou1 · Jiannan Dai1 · Bo Yu1 Received: 15 April 2020 / Accepted: 7 September 2020 © Springer Nature B.V. 2020
Abstract Local factors of plaque rupture (e.g. lipid burden) are related to preprocedural thrombolysis in myocardial infarction (TIMI) flow grade during primary percutaneous coronary intervention (PCI). However, the pathological mechanism differs between plaque erosion and rupture. We aimed to identify the factors associated with reduced TIMI flow in plaque erosion. A total of 329 ST-segment elevation myocardial infarction (STEMI) patients with optical coherence tomography (OCT) identified plaque erosion were divided into 2 groups by preprocedural TIMI flow grade [TIMI 0–1 group (n = 219) and TIMI 2–3 group (n = 110)]. Patients in TIMI 0–1 group were older (age > 50 years, 68.5% vs. 51.8%, P = 0.003), and had more diabetes mellitus (18.3% vs. 8.2%, P = 0.015). Plaque erosion with TIMI flow 0–1 was less frequently located in the left anterior descending artery (LAD, 58.4% vs. 72.7%, P = 0.011), but more frequently located in the right coronary artery (RCA, 34.2% vs. 7.3%, P = 0.001) than those with TIMI flow 2–3. TIMI 0–1 group had more lipid plaques (53.9% vs. 41.8%, P = 0.039), macrophage accumulation (59.8% vs. 41.8%, P = 0.002), and calcification (34.2% vs. 21.8%, P = 0.020). In the multivariable analysis, age > 50 years, diabetes mellitus, RCA location, and macrophage accumulation were the independent predictors of reduced TIMI flow grade in STEMI patients with plaque erosion. Systemic factors (older age and diabetes mellitus) and local factors (RCA location and macrophage accumulation) were independently associated with reduced coronary flow in STEMI patients with plaque erosion. Clinical trial registration ClinicalTrials.gov NCT03084991 May 17, 2017 (retrospectively registered). Keywords Acute myocardial infarction · Plaque erosion · Optical coherence tomography · Thrombolysis in myocardial infarction flow grade
Jifei Wang and Chao Fang contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10554-020-02021-1) contains supplementary material, which is available to authorized users. * Jiannan Dai [email protected] * Bo Yu [email protected] 1
Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin 150086, China
Introduction Reduced thrombolysis in myocardial infarction (TIMI) flo
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