ISSN 2996-8215
International Journal of Cardiology | Vol. 11, No. 5, May 2020 | pp. 33–40
DOI: 10.46882/2020/IJC/000134
Original Research Article
Diagnostic Utility of High-Resolution Intravascular OCT for Vulnerable Plaque Characterization in NSTE-ACS Patients
Giovanni Rossi¹, Matteo Bianchi¹, Elena Rossi²
¹Department of Cardiovascular Sciences, University Hospital of Bologna, Bologna, Italy
²Division of Interventional Cardiology, San Raffaele Hospital, Milan, Italy
Abstract:
Identifying vulnerable coronary atherosclerotic plaques prone to rupture is essential for optimizing acute coronary syndrome (ACS) interventions. Optical coherence tomography (OCT) offers high-resolution intravascular visualization, but its systematic diagnostic accuracy for characterizing thin-cap fibroatheromas (TCFA) requires verification against intravascular ultrasound (IVUS). This prospective clinical study evaluated the diagnostic performance of high-resolution intravascular OCT for identifying vulnerable TCFA structures in patients presenting with non-ST-segment elevation ACS (NSTE-ACS). We evaluated 120 patients with NSTE-ACS who underwent ad hoc coronary angiography accompanied by both OCT and radiofrequency IVUS imaging of the culprit vessel. TCFA was defined by OCT as a lipid-rich plaque with a fibrous cap thickness less than 65 μm. Intravascular imaging safely evaluated a total of 142 distinct plaques. OCT successfully identified 42 TCFAs, demonstrating a diagnostic sensitivity of 91.3% (95% CI: 79.2%–97.6%) and a specificity of 89.6% (95% CI: 81.7%–94.9%) using IVUS as the comparative reference. The mean fibrous cap thickness quantified by OCT was 54.2 ± 11.4 μm in the ruptured plaque cohort. Multivariable logistic regression revealed that an OCT-derived fibrous cap thickness less than 65 μm was an independent predictor of microvascular obstruction post-stenting (odds ratio: 3.24, 95% CI: 1.45–7.24, p = 0.004). Intravascular optical coherence tomography achieves excellent diagnostic accuracy for characterizing thin-cap fibroatheromas, providing high-resolution morphological tracking to optimize risk stratification in acute coronary syndrome.
Keywords: Optical coherence tomography, Intravascular ultrasound, Thin-cap fibroatheroma, Acute coronary syndrome, Vulnerable plaque, Diagnostic accuracy
Received: February 14, 2020; Revised: March 25, 2020; Accepted: April 10, 2020; Published: May 22, 2020