Garcia-Garcia, Hector M Hideo-Kajita, Alexandre Kuku, Kayode Ozaki, Yuichi Soud, Mohamad Tariq, Muhammad Ali

The Impact of Blood Pressure Variability on Coronary Arterial Lumen Dimensions as Assessed by Optical Coherence Tomography in Patients with ST-Elevation Myocardial Infarction. - 2019

BACKGROUND: Patients with ST-elevation Myocardial Infarction treated by primary percutaneous coronary intervention (PPCI) experience drastic hemodynamic systemic changes (i.e., blood pressure) during the different phases of the procedure. Optical coherence tomography is often used to unveil the underlying cause of STEMI (pre-PCI) and to optimize stent implantation (post-PCI). The impact of blood pressure variability on coronary lumen remains uncertain. This study aimed to investigate the relationship between blood pressure variability, before and after PCI, and coronary arterial lumen dimensions of the infarct-related artery. CONCLUSION: Despite significant hemodynamic variability, the difference in lumen cross-sectional area, between pre- and post-coronary artery stenting was minimal. This study supports the use of OCT lumen areas to inform clinical decisions during PPCI. Copyright (c) 2019 Elsevier Inc. All rights reserved. METHODS: We measured systolic, diastolic and mean arterial blood pressure (SBP, DBP, and MAP; respectively) at pre- and post-PCI. Frequency-domain optical coherence tomography (FD-OCT) imaging was performed at the same time points. Offline quantitative image analyses were performed to assess the average and minimum lumen area (LA). DELTA blood pressure (after and before the PCI) was then calculated. RESULTS: A total of 14 ST-segment elevation myocardial infarction (STEMI) patients were included. 84.2% of enrolled patients were male with a mean age of (58+/-10.7years). Roughly two-thirds (57.8%) had hypertension. The mean SBP was (112.6mmHg+/-16.1) and (117.2mmHg+/-20.9), pre- and post-stenting, respectively; the range of the observed SBP differences (between pre- and post-PCI) went from -25 to +23mmHg. Pre- and post-stenting mean average LA were (7.1+/-2.5mm2 and 6.8+/-2.3mm2; respectively). There were poor correlations between DELTASBP and DELTA mean minimum LA. A similar pattern was observed with DELTADBP and DELTAMAP.



10.1016/j.carrev.2019.05.027 [doi] S1553-8389(19)30327-6 [pii]

Treatment Outcome
*Tomography, Optical Coherence
Time Factors
ST Elevation Myocardial Infarction/th [Therapy]
*ST Elevation Myocardial Infarction/pp [Physiopathology]
*ST Elevation Myocardial Infarction/dg [Diagnostic Imaging]
ST Elevation Myocardial Infarction/co [Complications]
Risk Factors
Predictive Value of Tests
Percutaneous Coronary Intervention/is [Instrumentation]
Middle Aged
*Hypertension/pp [Physiopathology]
Hypertension/di [Diagnosis]
Hypertension/co [Complications]
*Coronary Vessels/pp [Physiopathology]
*Coronary Vessels/dg [Diagnostic Imaging]
*Arterial Pressure

MedStar Heart & Vascular Institute

Medicine/Internal Medicine

Journal Article

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