Optical coherence tomography with magnetic resonance angiography to assess STEMI non-culprit risk (OCT-RISK) (Dr Matthew Li Kam Wa)

Over half of those with ST-elevation myocardial infarction have multivessel disease.

Although it has become apparent that revascularisation of non-culprit disease prevents subsequent events, it is not clear which lesions warrant treatment. Contemporary strategies that are based on angiographic or functional significance at baseline are blunt tools.

Either approach will lead to the unnecessary revascularisation of stable lesions, whilst missing mild or insignificant lesions that may still lead to adverse outcomes.

Our aim is to assess whether high-resolution imaging with optical coherence tomography (OCT) and intracoronary physiology data can be combined with computational fluid dynamics (CFD) analysis to calculate coronary shear stress, and therefore better predict the natural history of non-culprit lesions.

We will also assess if it is possible to derive such prognostic information using magnetic resonance angiography (MRA) and CFD techniques.

Patients with non-culprit disease will be enrolled after primary angioplasty and will undergo OCT, coronary physiology and MRA at baseline, and then again at 6 months.

Development of improved invasive and non-invasive tools to risk stratify non-culprit lesions offers the potential for the targeted treatment or deferral of coronary disease, and a more personalised approach to the management of acute coronary syndromes.