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The combination assessment of lipid pool and thrombus by optical coherence tomography can predict the filter no-reflow in primary PCI for ST elevated myocardial infarction.

Abstract The usefulness of distal protection devices is still controversial. Moreover, there is no report on thrombus evaluation by using optical coherence tomography (OCT) for determining whether to use a distal protection device. The aim of the present study was to investigate the predictor of filter no-reflow (FNR) by using OCT in primary percutaneous coronary intervention (PCI) for ST-elevated acute myocardial infarction (STEMI).We performed preinterventional OCT in 25 patients with STEMI who were undergoing primary PCI with Filtrap. FNR was defined as coronary flow decreasing to TIMI flow grade 0 after mechanical dilatation.FNR was observed in 13 cases (52%). In the comparisons between cases with or without the FNR, the stent length, lipid pool length, lipid pool + thrombus length, and lipid pool + thrombus index showed significant differences. In multivariate analysis, lipid pool + thrombus length was the only independent predictor of FNR (OR 1.438, 95% CI 1.001 - 2.064, P < .05). The optimal cut-off value of lipid pool + thrombus length for predicting FNR was 13.1 mm (AUC = 0.840, sensitivity 76.9%, specificity 75.0%). Moreover, when adding the evaluation of thrombus length to that of lipid pool length, the prediction accuracy of FNR further increased (IDI 0.14: 0.019-0.25, P = .023).The longitudinal length of the lipid pool plus thrombus was an independent predictor of FNR and the prediction accuracy improved by adding the thrombus to the lipid pool. These results might be useful for making intraoperative judgment about whether filter devices should be applied in primary PCI for STEMI.
PMID
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Longitudinal extent of lipid pool assessed by optical coherence tomography predicts microvascular no-reflow after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

Authors

Mayor MeshTerms

Percutaneous Coronary Intervention

Tomography, Optical Coherence

Keywords
Journal Title medicine
Publication Year Start




PMID- 29390391
OWN - NLM
STAT- MEDLINE
DCOM- 20180212
LR  - 20180212
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 50
DP  - 2017 Dec
TI  - The combination assessment of lipid pool and thrombus by optical coherence
      tomography can predict the filter no-reflow in primary PCI for ST elevated
      myocardial infarction.
PG  - e9297
LID - 10.1097/MD.0000000000009297 [doi]
AB  - The usefulness of distal protection devices is still controversial. Moreover,
      there is no report on thrombus evaluation by using optical coherence tomography
      (OCT) for determining whether to use a distal protection device. The aim of the
      present study was to investigate the predictor of filter no-reflow (FNR) by using
      OCT in primary percutaneous coronary intervention (PCI) for ST-elevated acute
      myocardial infarction (STEMI).We performed preinterventional OCT in 25 patients
      with STEMI who were undergoing primary PCI with Filtrap. FNR was defined as
      coronary flow decreasing to TIMI flow grade 0 after mechanical dilatation.FNR was
      observed in 13 cases (52%). In the comparisons between cases with or without the 
      FNR, the stent length, lipid pool length, lipid pool + thrombus length, and lipid
      pool + thrombus index showed significant differences. In multivariate analysis,
      lipid pool + thrombus length was the only independent predictor of FNR (OR 1.438,
      95% CI 1.001 - 2.064, P &lt; .05). The optimal cut-off value of lipid pool +
      thrombus length for predicting FNR was 13.1 mm (AUC = 0.840, sensitivity 76.9%,
      specificity 75.0%). Moreover, when adding the evaluation of thrombus length to
      that of lipid pool length, the prediction accuracy of FNR further increased (IDI 
      0.14: 0.019-0.25, P = .023).The longitudinal length of the lipid pool plus
      thrombus was an independent predictor of FNR and the prediction accuracy improved
      by adding the thrombus to the lipid pool. These results might be useful for
      making intraoperative judgment about whether filter devices should be applied in 
      primary PCI for STEMI.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Negishi, Yosuke
AU  - Negishi Y
AD  - Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 
      Japan.
FAU - Ishii, Hideki
AU  - Ishii H
AD  - Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 
      Japan.
FAU - Suzuki, Susumu
AU  - Suzuki S
AD  - Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 
      Japan.
FAU - Aoki, Toshijiro
AU  - Aoki T
AD  - Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 
      Japan.
FAU - Iwakawa, Naoki
AU  - Iwakawa N
AD  - Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 
      Japan.
FAU - Kojima, Hiroki
AU  - Kojima H
AD  - Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 
      Japan.
FAU - Harada, Kazuhiro
AU  - Harada K
AD  - Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 
      Japan.
FAU - Hirayama, Kenshi
AU  - Hirayama K
AD  - Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 
      Japan.
FAU - Mitsuda, Takayuki
AU  - Mitsuda T
AD  - Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 
      Japan.
FAU - Sumi, Takuya
AU  - Sumi T
AD  - Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 
      Japan.
FAU - Tanaka, Akihito
AU  - Tanaka A
AD  - Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 
      Japan.
FAU - Ogawa, Yasuhiro
AU  - Ogawa Y
AD  - Department of Cardiology, Komaki City Hospital, Aichi, Japan.
FAU - Kawaguchi, Katsuhiro
AU  - Kawaguchi K
AD  - Department of Cardiology, Komaki City Hospital, Aichi, Japan.
FAU - Murohara, Toyoaki
AU  - Murohara T
AD  - Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, 
      Japan.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Lipids)
SB  - AIM
SB  - IM
MH  - Coronary Angiography
MH  - Coronary Thrombosis/*diagnostic imaging
MH  - Cross-Sectional Studies
MH  - Female
MH  - Humans
MH  - Lipids/*analysis
MH  - Male
MH  - Middle Aged
MH  - Myocardial Reperfusion
MH  - No-Reflow Phenomenon/diagnostic imaging
MH  - *Percutaneous Coronary Intervention
MH  - ST Elevation Myocardial Infarction/*diagnostic imaging/*surgery
MH  - *Tomography, Optical Coherence
EDAT- 2018/02/03 06:00
MHDA- 2018/02/13 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/13 06:00 [medline]
AID - 10.1097/MD.0000000000009297 [doi]
AID - 00005792-201712150-00141 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(50):e9297. doi: 10.1097/MD.0000000000009297.