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Optical coherence tomography features of angiographic complex and smooth lesions in acute coronary syndromes

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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.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Institute of Cardiology, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168, Rome, Italy

    Hesham Refaat, Giampaolo Niccoli, Mario Gramegna, Rocco A. Montone, Francesco Burzotta, Antonio M. Leone, Carlo Trani, Giancarla Scalone & Filippo Crea

  2. Cardiology Department, Zagazig University, Zagazig, Egypt

    Hesham Refaat, Ahmed S. Ammar & Islam A. Elsherbiny

  3. Centro per la Lotta contro l’Infarto - Fondazione Onlus, Rome, Italy

    Francesco Prati

  4. San Giovanni-Addolorata Hospital, Rome, Italy

    Francesco Prati

Authors
  1. Hesham Refaat
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  2. Giampaolo Niccoli
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  3. Mario Gramegna
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  4. Rocco A. Montone
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  5. Francesco Burzotta
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  6. Antonio M. Leone
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  7. Carlo Trani
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  8. Ahmed S. Ammar
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  9. Islam A. Elsherbiny
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  10. Giancarla Scalone
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  11. Francesco Prati
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  12. Filippo Crea
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Corresponding author

Correspondence to Giampaolo Niccoli.

Additional information

Hesham Refaat and Giampaolo Niccoli have equally contributed to the manuscript as first authors.

Electronic supplementary material

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10554_2015_632_MOESM1_ESM.doc

Supplementary Data: OCT image analysis including culprit plaque morphology and plaque characterization, is described in details in the online appendix (DOC 33 kb)

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Refaat, H., Niccoli, G., Gramegna, M. et al. Optical coherence tomography features of angiographic complex and smooth lesions in acute coronary syndromes. Int J Cardiovasc Imaging 31, 927–934 (2015). https://doi.org/10.1007/s10554-015-0632-z

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  • DOI: https://doi.org/10.1007/s10554-015-0632-z

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