A case of STEMI with post-MI Angina: Role of intravascular imaging

in Max Super Speciality Hospital, Dehradun

Apr 18 , 2023

A 50-year-old normotensive, euglycemic, smoker man with a history of a recent inferior wall MI, post-PTCA to LCX, came to Max Super Speciality Hospital, Dehradun, with complaints of chest pain on minimal exertion for a few days. His vitals were normal, and ECG showed q and T wave inversion in leads II, III, and AVF. 2D Echo showed LVEF 50% with RWMA in the inferior territory. Diagnostic angiogram revealed OM- 80% stenosis, LAD 50% stenosis.

An acute coronary syndrome (ACS) is, in principle, a focal manifestation arising from a single lesion. Multiple lesion instability is commonly observed in atherothrombosis. Thus, non-culprit lesions of patients with MI have a more complex angiographic morphology and are associated with rapid lesion progression and increased event rates at follow-up. OCT can more accurately assess complicated plaque morphology and thrombus in ACS compared with intravascular ultrasound (IVUS). ACS due to Plaque ruptures were reported to have larger infarcts, poorer LV functions and higher chances of No reflow phenomena with PCI. In young patients of ACS without major risk factors, one can predict Plaque erosion and OCT must be planned while performing CAG to confirm the diagnosis. There is a need for large-scale randomised trials in ACS with Plaque erosion and Plaque rupture, comparing conservative with conventional invasive management. Statin therapy has been shown to induce plaque stabilisation and leads to a significant reduction in cardiovascular events. The eects of other systemic, mostly anti-inflammatory, drug therapies on cardiovascular outcome are currently being studied in large clinical trials.