Part of myocardial infarction can not put stent!Yu Bo et al. EROSION III study published


In a study published in THE Journal JACC on 30 March, EROSION III, led by Bo Yu of the Second Affiliated Hospital of Harbin Medical University, suggested that reperfusion therapy guided by optical coherence tomography (OCT), compared with coronary angiography, could be used to treat st-segment elevation myocardial infarction (STEMI) in patients with early unblocked infarction vessels.Fewer stents were placed in emergency coronary interventions.These findings suggest the value of OCT in optimizing reperfusion therapy strategies for STEMI patients.The EROSION III study was an open-label, prospective, multicenter, randomized controlled study of 246 STEMI patients, 226 of whom were included in the conformed protocol analysis set, 112 of whom were randomized to OCT-guided reperfusion therapy (OCT group) and 114 to coronary angiography guided reperfusion therapy (angiography group).These patients had coronary angiographic stenosis ≤70% and HAD grade 3 TIMI blood flow at admission or after restoration of forward blood flow.Before randomization, the rate of coronary artery stenosis in the OCT group and angiography group was 54% and 53.5%, respectively, with no significant difference between the two groups.Stent placement rates in the OCT group and angiography group were 43.8% and 58.8%, respectively, indicating a 15% reduction in OCT-guided stent placement.Among patients with stents, the rate of residual diameter stenosis was significantly lower in the OCT group than in the contrast group (8.7% vs. 11.8%).There was no significant difference in the incidence of the primary safety endpoint (1-month thrombosis and ischemic events) between the two groups (1.8% vs. 2.6%), with one cardiac death and one stable angina in the OCT group.Cardiogenic death occurred in 3 patients in contrast group.There was no recurrence of myocardial infarction in either group.At 1 year, the projected incidence of cardiovascular and cerebrovascular events remained comparable between the two groups (11.6% vs 9.6%).In this study, OCT was used to assess criminal lesions qualitatively and quantitatively, and non-stent strategies were recommended in the case of plaque erosion, plaque rupture without dissection and/or hematoma evidence, and spontaneous coronary dissection.When stent placement is required, OCT is used to guide and optimize surgery, often with more posterior dilation and less stent placement.About 2/3 of the patients had coronary plaque rupture, of which 40.5% were not stented;Coronary plaque erosion occurred in about 1/4 of the patients, and 86.2% of them were not stented.The rest were coronary calcification plaque or other types, and the vast majority were not stented.The study shows that OCT may be useful for precision therapy in highly selected patients, the review experts said.At the same time, the study is a useful reminder that not all ST-elevation acs are created equal, and that some of the convict plaque phenotypes with relatively good outcomes are the result of contemporary preventive interventions that have somehow altered the pattern and behavior of atherosclerosis in humans.Source:[1]EROSION III: A Multicenter RCT of OCT-Guided Reperfusion in STEMI With Early Infarct Artery Patency. J Am Coll Cardiol Intv. Mar 30, 2022.[2]Culprit Lesions Phenotypes in ST-Segment Elevation Acute Coronary Syndromes: A Call for Precision Medicine. J Am Coll Cardiol Intv. Mar 30, 2022. Many difficult and complicated cases, a doctor can only see once in his life please contact: 18656052587(wechat) or zgxhzz@vip.163.com

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