Despite major advances in secondary prevention and reperfusion strategies, acute myocardial infarction (AMI) still causes morbidity and mortality. A significant portion of acute events arise from mild to moderate lesions identified months to years before the index event. Early detection of lesions at higher risk of progression and rupture may allow for more targeted treatment and, in turn, slow the pathological process. However, routine use of imaging techniques to assess mild to moderate lesions in daily practice is not cost-effective.
Authors proposed an analysis of angiographically derived radial wall strain (RWS) through the variation of the luminal diameter within the cardiac cycle in an angiographic view. A high stress pattern identified as maximum RWS >12% has been correlated with plaque vulnerability derived from optical coherence tomography (OCT). This method allows for the assessment of lesion risk without additional imaging.
The aim of this retrospective study was to investigate the association between baseline RWS and subsequent AMI related to mild to moderate lesions.
The analysis included 1981 patients from a hospital in China between January 2013 and December 2019; 44 patients were in the AMI group and 1937 patients, in the control group.
After propensity score matching, 44 patients in the AMI group and 132 in the control group were selected for analysis. Mean patient age was 64 years old, and most subjects were male. The most frequent clinical presentation was non-ST-segment elevation acute myocardial infarction (NSTEMI; 75%), followed by ST-segment elevation acute myocardial infarction (STEMI; 25%).
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The most affected artery was the right coronary artery (61.4%) followed by the anterior descending artery (29.5%). The mean diameter of the evaluated stenoses was 34%. Baseline maximum RWS was significantly higher in AMI-culprit lesions compared with those that remained quiescent (mean 13% vs. 10%; p < 0.001). Maximum RWS was predictive of lesion-related AMI with an area under the curve of 0.83 (95% confidence interval [CI]: 0.76-0.90; p < 0.001), and a cutoff value >12. Finally, RWS >12% was independently associated with a risk of subsequent AMI of 7.25 (95% CI: 3.94-13.37; p < 0.001).
Conclusion
A high RWS pattern detected by angiography allows for the identification of mild to moderate lesions with increased risk of future AMI. These findings indicate a potential role of RWS in plaque rupture, and using this tool could allow for a better stratification. Prospective studies with a larger population are needed to confirm these results.
Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.
Original Title: The Association Between Angiographically Derived Radial Wall Strain and the Risk of Acute Myocardial Infarction.
Reference: Chenguang Li, MD et al J Am Coll Cardiol Intv 2023;16:1039–1049.
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