Pre-infarction Angina and Culprit Lesion Morphologies in Patients with a First ST-segment Elevation Acute Myocardial Infarction: Insights from In Vivo Optical Coherence Tomography.

AIMS: This study aimed to evaluate the relationship between pre-infarction angina (PIA) and in vivo culprit lesion characteristics as assessed by intravascular optical coherence tomography (OCT) in patients with a first ST-segment elevation myocardial infarction (STEMI).

METHODS AND RESULTS: A total of 305 consecutive patients with a first STEMI who underwent OCT imaging of culprit lesions during primary percutaneous coronary intervention (PCI) were prospectively enrolled. OCT findings of the culprit plaque were compared between patients with (n=206) and without PIA (n=99). Patients with PIA showed lower rates of thin-cap fibroatheroma (TCFA) (62.6% vs. 80.8%, P=0.001) and plaque rupture (56.8% vs. 72.7%, P=0.007), smaller maximum ruptured cavity areas (1.10±1.04 mm2 vs. 1.53±1.20 mm2, P=0.002), and more severe residual luminal narrowing (P=0.015) with a higher incidence of white residual thrombus (68.4% vs. 50.0%, P=0.003) at the culprit lesions than patients without PIA. No significant differences in clinical outcomes were observed at the 1-year follow-up.

CONCLUSIONS: In patients with a first STEMI, PIA was significantly associated with a lower incidence of TCFA and plaque rupture, a smaller ruptured cavity area, more white residual thrombi, and more severe lumen stenosis at the culprit lesions.

TRIAL REGISTRATION NUMBER: NCT03107624.