In Vivo Diagnosis of Plaque Erosion and Calcified Nodule in Patients with Acute Coronary Syndrome by Intravascular Optical Coherence Tomography

By H. Jia, Farhad Abtahian, A. Aguirre, S. Lee, S. Chia, H. Lowe, Koji Kato, T. Yonetsu, R. Vergallo, Sining Hu and 20 more. Journal of the American College of Cardiology, 2013

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Objectives To characterize the morphological features of plaque erosion and calcified nodule in patients with acute coronary syndrome (ACS) by optical coherence tomography (OCT). Background Plaque erosion and calcified nodule have not been systematically investigated in vivo. Methods One hundred and twenty-six patients with ACS who had undergone pre-intervention OCT imaging were included. The culprit lesions were classified as plaque rupture (PR), erosion (OCT-erosion), calcified nodule (OCT-CN), or others using a new set of diagnostic criteria for OCT. Results The incidences of PR, OCT-erosion, and OCT-CN were 43.7%, 31.0%, and 7.9%, respectively. Patients with OCT-erosion were the youngest compared with those with PR and OCT-CN (53.8±13.1 years vs. 60.6±11.5 years, 65.1±5.0 years, p=0.005). Compared with patients with PR, presentation with non-ST-segment elevation ACS (NSTE-ACS) was more common in patients with OCT-erosion (61.5% vs. 29.1%, p=0.008) and OCT-CN (100% vs. 29.1%, p<0.001). OCT-erosion had a lower frequency of lipid plaque (43.6% vs. 100%, p<0.001), thicker fibrous cap (169.3±99.1 μm vs. 60.4±16.6 μm, p<0.001), and smaller lipid arc (202.8±73.6° vs. 275.8±60.4°, p<0.001) than PR. The diameter stenosis was least severe in OCT-erosion followed by OCT-CN and PR (55.4±14.7% vs. 66.1±13.5% vs. 68.8±12.9%, p<0.001). Conclusions OCT is a promising modality for identifying OCT-erosion and OCT-CN in vivo. OCT-erosion is a frequent finding in patients with ACS, especially in those with NSTE-ACS and younger patients. OCT-CN is the least common etiology for ACS and is more common in older patients.

Subfields: Pulmonary and Respiratory Medicine, Radiology, Nuclear Medicine and Imaging, Surgery

View Paper: https://www.semanticscholar.org/paper/43ae3346e629875e56a87b7a229ebc71ce3e0ee8

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In Pulmonary and Respiratory Medicine

  1. Erling Falk
  2. Renu Virmani
  3. J. Bentzon
  4. F. Otsuka

In Radiology, Nuclear Medicine and Imaging

  1. Erling Falk
  2. J. Bentzon
  3. Renu Virmani

In Surgery

  1. Erling Falk
  2. J. Bentzon
  3. F. Otsuka
  4. Renu Virmani

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