Coronary Artery Disease, Ischemic Heart Disease, ST Elevation Myocardial Infarction
Conditions
Keywords
optical coherence tomography, non-culprit, magnetic resonance imaging, cardiac magnetic resonance, STEMI, magnetic resonance angiography, OCT
Brief summary
Heart attacks caused by the complete blockage of a heart artery are treated by opening it with a stent. However, most people will also have 'non-culprit' narrowings found in their other arteries at this time. Although in general people do better if these non-culprit narrowings are also treated with stents if they look severe, this process has problems. This is because narrowings that look severe may be stable and not cause any trouble. For these people a stent is a wasted procedure and unnecessary risk. On the other hand, narrowings that are currently left alone because they appear mild, may progress and cause a heart attack. Participants who have had a heart attack will have a scan from inside the heart arteries during an angiogram (optical coherence tomography, OCT) and a magnetic resonance angiogram (MRA). If the investigators can show that it is possible to accurately predict which non-culprit narrowings are going to progress and which are going to stabilise, medical professionals may be able to better target their treatments after a heart attack.
Interventions
DIAGNOSTIC_TESTOptical coherence tomography and pressure wire assessment
Non-culprit coronary arteries
DIAGNOSTIC_TESTCardiac magnetic resonance angiogram
1.5T
Sponsors
Guy's and St Thomas' NHS Foundation Trust
King's College London
Imperial College London
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Successful primary percutaneous coronary intervention (PCI) within the previous week with no major complications at the index procedure * Bystander disease in a non-culprit vessel planned for clinically indicated staged angiography +/- PCI * Able to provide written informed consent.
Exclusion criteria
* Cardiogenic shock requiring intubation, inotropes or a mechanical support device * Creatinine clearance \<30ml/min * Prior coronary artery bypass grafting * Life expectancy less than 3 years * Pregnancy. * Target lesion in the left main coronary artery * Severe calcification or tortuosity that would threaten safe placement of a pressure wire or OCT catheter * Chronic total occlusion of a major epicardial vessel.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Change in mean fibrous cap thickness measured by optical coherence tomography | 6 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in mean lipid arc measured by optical coherence tomography | 6 months | — |
| Presence of thin cap fibroatheroma measured by optical coherence tomography | 6 months | Plaque with lipid arc \>90° and fibrous cap thickness ≤65µm |
| Change in measures of shear stress made by optical coherence tomography and magnetic resonance angiography | 0 and 6 months | Comparison between non-invasive and invasively derived measures |
Countries
United Kingdom
Contacts
PRINCIPAL_INVESTIGATORDivaka Perera, MD
King's College London
Outcome results
None listed