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Optical coherence tomography features of angiographic complex and smooth lesions in acute coronary syndromes.
- Source :
-
The international journal of cardiovascular imaging [Int J Cardiovasc Imaging] 2015 Jun; Vol. 31 (5), pp. 927-34. Date of Electronic Publication: 2015 Feb 28. - Publication Year :
- 2015
-
Abstract
- Plaque rupture (PR) and superimposed thrombosis have been shown as the most frequent underlying substrate in acute coronary syndromes (ACS). Coronary angiography is a luminogram not able to define in vivo features of the culprit plaques. The aim of the study was to use optical coherence tomography (OCT) to investigate the pathology underlying complex (CL) and non-complex angiographic lesions (NCL). We retrospectively enrolled 107 ACS patients admitted to our institution; 83 with non-ST elevation ACS (NSTE-ACS) and 24 with ST-elevation myocardial infarction. Coronary angiography was performed and culprit lesions were classified according to Ambrose criteria into NCL (n = 47) and CL (n = 60). OCT imaging was then performed to better identify plaque morphology; either PR or intact fibrous cap, the presence of superimposed thrombosis, lipid rich plaque, and thin cap fibroatheroma (TCFA). OCT analysis showed that 58 lesions (54.2%) were classified as PR and 48 lesions (44.9%) were associated with thrombi. Lipid rich plaques were identified in 62 lesions (57.9%). PR, intracoronary thrombi, lipid rich plaques and TCFA were more frequent in CL compared with NCL (71.7 vs 31.9%, 63.3 vs 21.3%, 71.7 vs 40.4% and 46.7 vs 21.3% respectively), but PR with superimposed thrombus may be also detected in NCL. OCT demonstrates PR and thrombosis in the majority of ACS patients presenting with CL. However, one-third of NCL show PR by OCT, suggesting that additional intracoronary imaging by OCT may better identify the underlying mechanism of coronary instability than coronary angiography alone.
- Subjects :
- Acute Coronary Syndrome diagnostic imaging
Acute Coronary Syndrome metabolism
Acute Coronary Syndrome pathology
Aged
Coronary Vessels chemistry
Female
Fibrosis
Humans
Lipids analysis
Male
Middle Aged
Myocardial Infarction diagnostic imaging
Myocardial Infarction metabolism
Myocardial Infarction pathology
Predictive Value of Tests
Radiographic Image Interpretation, Computer-Assisted
Radionuclide Imaging
Retrospective Studies
Rupture, Spontaneous
Thrombosis diagnostic imaging
Thrombosis pathology
Acute Coronary Syndrome diagnosis
Coronary Angiography
Coronary Vessels diagnostic imaging
Coronary Vessels pathology
Myocardial Infarction diagnosis
Plaque, Atherosclerotic
Tomography, Optical Coherence
Subjects
Details
- Language :
- English
- ISSN :
- 1875-8312
- Volume :
- 31
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The international journal of cardiovascular imaging
- Publication Type :
- Academic Journal
- Accession number :
- 25724566
- Full Text :
- https://doi.org/10.1007/s10554-015-0632-z