Pediatric Cardiology & Healthcare

Biography

Biography: Chiara Bernelli

Abstract

Objectives: To investigate the impact of culprit plaque and atherothrombotic components on incomplete stent apposition (ISA) in patients with ST-segment Elevation Myocardial Infarction. (STEMI) Background: The role of the culprit plaque and related atherothrombotic components on ISA occurrence after primary percutaneous coronary intervention (p-PCI) is unknown. Methods: STEMI patients undergoing p-PCI with everolimus-eluting stent (EES) were prospectively investigated with Optical Coherence Tomography (OCT) of the infarct-related artery before, after stenting and at 9-month follow-up. Data derived from serial OCT, histopathological analysis of thrombus-aspirates and serum inflammatory biomarkers were analyzed. Results: 114 patients with 114 EES-treated lesions were evaluated. Acute-ISA occurred in 82 (71.9%), preferentially in larger vessels, with a median area of 0.2 mm2 [IQR 0.1-0.4]. The presence of thrombus before stent implantation (OR 5.5, 95%CI [1.1-26.9], p=0.04) and the lipid content in the target segment (OR 1.3, 95%CI [1.0-1.5], p=0.04) independently predicted acute ISA. At 9-month, ISA persisted in 46 (56.1%) lesions, significantly predicted by the volume of acute-ISA (OR 1.3, 95%CI [1.1-1.5], p=0.01). Late-acquired ISA occurred in 39 (34.2%) lesions with a median area of 0.3 [0.1-0.4] mm2. Red/ mixed thrombus before stent implantation (OR 3.7, 95%CI [1.0-13.3], p=0.05) and length of the underlying ruptured plaque (OR 1.7, 95%CI [1.1-2.8], p=0.02) were independently associated with late-acquired ISA. Conclusions: In STEMI patients undergoing p-PCI, culprit plaque and atherothrombotic components of the infarct-related artery significantly contribute to the onset of acute- and late ISA. ISA persistency at follow-up depends on the initial volume of malapposition.