Diagnosis and Management of STEMI Arising From Plaque Erosion

THE DICTIONARY DEFINES PROGRESS AS "MOVEMENT TOWARD A GOAL." In the following iFORUM editorials, we have thoughtful arguments favoring and opposed to a more detailed evaluation of patients with ST-segment elevation myocardial infarction (STEMI) before angioplasty and stent placement. Holmes and Lerman (See, Think, Act) argue that distinguishing between plaque rupture and plaque erosion as the cause of STEMI might be helpful to personalize therapy, with the goal of improving care and long-term outcome. By contrast, Moreno, King, and Sharma (Just Act) argue that major advances in the care of patients with STEMI have been made over the last 3 decades supporting the value of rapid restoration of flow and acute angioplasty/stent to treat residual stenosis in these patients. This rapid definitive therapy has produced demonstrable improvement in patient outcome. Moreno et al. argue that the incidence of plaque erosion as a cause of STEMI is likely to be low; additional evaluation of patients before sent and angioplasty is unlikely to improve outcome. Given our current state of understanding, it is apparent that much more data are necessary before clinical guidance is available about the role of optical coherence tomography (OCT) in the selection of therapy in patients with STEMI. However, it is also clear that applying high-resolution intravascular imaging with OCT will allow us to advance our understanding of the etiology of STEMI. That information should lead to progress. © 2013 American College of Cardiology Foundation.