PMID- 33251922 OWN - NLM STAT- MEDLINE DCOM- 20210316 LR - 20210318 IS - 2047-9980 (Electronic) IS - 2047-9980 (Linking) VI - 9 IP - 24 DP - 2020 Dec 15 TI - Prevalence, Features, and Prognosis of Artery-to-Artery Embolic ST-Segment-Elevation Myocardial Infarction: An Optical Coherence Tomography Study. PG - e017661 LID - 10.1161/JAHA.120.017661 [doi] LID - e017661 AB - Background The major underlying mechanisms contributing to acute coronary syndrome are plaque rupture, plaque erosion, and calcified nodule. Artery-to-artery embolic myocardial infarction (AAEMI) was defined as ST-segment-elevation myocardial infarction caused by migrating thrombus formed at the proximal ruptured plaque. The aim of this study was to investigate the prevalence and clinical features of AAEMI by using optical coherence tomography. Methods and Results This study retrospectively enrolled 297 patients with ST-segment-elevation myocardial infarction who underwent optical coherence tomography before percutaneous coronary intervention. Patients were divided into 4 groups consisting of plaque rupture, plaque erosion, calcified nodule, and AAEMI according to optical coherence tomography findings. The prevalence of AAEMI was 3.4%. The culprit vessel in 60% of patients with AAEMI was right coronary artery. Minimum lumen area at the culprit site was larger in AAEMI compared with plaque rupture, plaque erosion, and calcified nodule (4.0 mm(2) [interquartile range (IQR), 2.2-4.9] versus 1.0 mm(2) [IQR, 0.8-1.3] versus 1.0 mm(2) [IQR, 0.8-1.2] versus 1.1 mm(2) [IQR, 0.7-1.6], P<0.001). Lumen area at the rupture site was larger in patients with AAEMI compared with patients with plaque rupture (4.4 mm(2) [IQR, 2.5-6.7] versus 1.5 mm(2) [IQR, 1.0-2.4], P<0.001). In patients with AAEMI, the median minimum lumen area at the occlusion site was 1.2 mm(2) (IQR, 1.0-2.1), 40% of them had nonstent strategy, and the 3-year major adverse cardiac event rate was 0%. Conclusions AAEMI is a rare cause for ST-segment-elevation myocardial infarction and has unique morphological features of plaque including larger lumen area at rupture site and smaller lumen area at the occlusion site. FAU - Takahata, Masahiro AU - Takahata M AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Ino, Yasushi AU - Ino Y AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Kubo, Takashi AU - Kubo T AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Tanimoto, Takashi AU - Tanimoto T AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Taruya, Akira AU - Taruya A AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Terada, Kosei AU - Terada K AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Emori, Hiroki AU - Emori H AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Higashioka, Daisuke AU - Higashioka D AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Katayama, Yosuke AU - Katayama Y AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Khalifa, Amir Kh M AU - Khalifa AKM AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Wada, Teruaki AU - Wada T AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Ozaki, Yuichi AU - Ozaki Y AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Shimamura, Kunihiro AU - Shimamura K AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Shiono, Yasutsugu AU - Shiono Y AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Kashiwagi, Manabu AU - Kashiwagi M AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Kuroi, Akio AU - Kuroi A AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Fujita, Suwako AU - Fujita S AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Tanaka, Atsushi AU - Tanaka A AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Hozumi, Takeshi AU - Hozumi T AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. FAU - Akasaka, Takashi AU - Akasaka T AD - Department of Cardiovascular Medicine Wakayama Medical University Wakayama Japan. LA - eng PT - Journal Article DEP - 20201130 PL - England TA - J Am Heart Assoc JT - Journal of the American Heart Association JID - 101580524 SB - IM MH - Aged MH - Aged, 80 and over MH - Case-Control Studies MH - Coronary Vessels/*diagnostic imaging/pathology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Myocardial Infarction/*complications/epidemiology/pathology MH - Percutaneous Coronary Intervention MH - Plaque, Atherosclerotic/pathology MH - Prevalence MH - Prognosis MH - Retrospective Studies MH - Rupture, Spontaneous/complications MH - ST Elevation Myocardial Infarction/diagnosis/*etiology/physiopathology MH - Thrombosis/complications/pathology MH - Tomography, Optical Coherence/*methods PMC - PMC7955389 OTO - NOTNLM OT - ST-segment-elevation myocardial infarction OT - artery-to-artery embolic myocardial infarction OT - optical coherence tomography OT - plaque rupture COIS- Dr Kubo has received lecture fees from Abbott Vascular and Terumo. Dr Akasaka has received lecture fees from Abbott Vascular and Terumo, and research grants from Abbott Vascular and Terumo. All other authors have no relationships to disclose relevant to the content of this article. EDAT- 2020/12/01 06:00 MHDA- 2021/03/17 06:00 PMCR- 2020/12/15 CRDT- 2020/11/30 08:41 PHST- 2020/12/01 06:00 [pubmed] PHST- 2021/03/17 06:00 [medline] PHST- 2020/11/30 08:41 [entrez] PHST- 2020/12/15 00:00 [pmc-release] AID - JAH35684 [pii] AID - 10.1161/JAHA.120.017661 [doi] PST - ppublish SO - J Am Heart Assoc. 2020 Dec 15;9(24):e017661. doi: 10.1161/JAHA.120.017661. Epub 2020 Nov 30.