Visualising the vesselsJuly 16, 2018
Can we avert future events in younger heart-attack patients by probing into their arteries? A new Indian study explores
A New Delhi-based cardiologist has initiated a first-of-its-kind clinical study to assess the status of `non culprit’ coronary arteries of younger patients of Acute Coronary Syndrome (ACS).
The investigator-initiated trial is being conducted by Prof.(Dr) Upendra Kaul, Chairman Cardiology and Executive Director and Dean at Batra Hospital and Medical Research Centre, New Delhi. It employs vessel-wall visualisation technology to decide upon the future course of action.
Named ACS-OCT India study, the trials will be carried out at 10 centres in India on 100 patients who recently had heart attacks and are below 45 years of age.
Usually, Acute Coronary Syndrome, or a heart attack, occurs as a result of a sudden blockage of one of the three arteries supplying blood to the heart. These vessels, which are directly involved in the event, are referred to as the culprit arteries.
ACS is the result of atherosclerosis. Being an inflammatory process, it is assumed that it could involve all the arteries to some extent. Therefore, an assessment of the degree of inflammation in other arteries could have a bearing on the long-term prognosis of the patient.
Vessels, which are not directly responsible for the recent acute attack, may also be having occlusions of intermediate severity, in addition to signs of inflammation, erosion and plaque rupture etc. Such situations often present a dilemma for cardiologists on whether to go for procedures like angioplasty or stenting.
In such cases, conducting a voyage through the patient’s arteries during the acute phase, along with follow-ups, would be of interest in prognosticating and evaluating the need for angioplasty. In addition, such data would help the caregiver decide the intensity of the drug regimen and optimize the
medical treatment consisting of blood thinners and drugs to control cholesterol, blood pressure, diabetes, smoking etc.
In fact, the visualization of the interior of these arteries can help treatment be more effective in reducing inflammation and preventing clot formation that can lead to further blockages in the arteries by preventing clot formation.
Dr Upendra Kaul
Batra Hospital and Medical Research Centre, New Delhi.
To achieve this, doctors use modern visualisation technologies such as Optical Coherence Tomography (OCT) and Fractional Flow Reserve Measurement (FFR), as routine angiography has limitations in assessing the physiology and studying the morphology of these artery walls.
The ACS-OCT India study employs both these methods in non-culprit vessels to chart the course of treatment. The study also aims to follow these patients for several years and perform a repeat OCT and FFR after one year.