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Morphological findings in typical variant angina presenting as acute coronary syndrome using optical coherence
Hwan-Cheol Park1, Sung Il Choi, Jae Ung Lee
1Division of Cardiology, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea.
Insights
Microthrombi and intimal erosion are key findings in vasospasm-induced acute coronary syndrome (ACS) detected by optical coherence tomography (OCT). These morphological changes are crucial for understanding ACS causes and guiding treatment strategies.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Coronary vasospasm is a significant cause of various cardiac events, including variant angina, myocardial infarction, and sudden cardiac death.
- Acute coronary syndrome (ACS) can be triggered by vasospastic lesions in coronary arteries.
- Optical coherence tomography (OCT) is a novel imaging technique used to evaluate morphological changes in vasospastic lesions.
Purpose of the Study:
- To evaluate the morphological changes associated with vasospasm-induced ACS using OCT.
- To identify key OCT findings in patients experiencing vasospasm-induced ACS.
Main Methods:
- Twenty patients with vasospasm-induced ACS, characterized by chest pain and transient ST segment elevation, were included.
- Patients had no significant coronary artery disease and positive provocation test results.
- OCT examinations were performed to assess vasospastic lesions.
Main Results:
- Intraluminal thrombi were observed in 33.3% of patients, and intimal erosion in 10%.
- Higher high-sensitivity C-reactive protein levels were noted in patients with microthrombi compared to those without (P=0.022).
- No significant differences were found in cardiac troponin-I levels, creatinine kinase-myocardial band isoenzyme, cholesterol, pain duration, stenosis, lesion length, or coronary risk factors between groups.
Conclusions:
- Microthrombi, with or without intimal erosion, represent significant abnormal morphological findings in OCT for vasospasm-induced ACS.
- Further large-scale studies are necessary to validate these findings.
Background:
Coronary vasospasm causes variant angina, as well as acute myocardial infarction, ventricular tachycardia, and sudden cardiac death. We evaluated morphological changes due to vasospastic lesions, which may cause acute coronary syndrome (ACS), using a novel technique called optical coherence tomography (OCT).
Methods:
Twenty patients (40-83 years old, 19 males) with vasospasm-induced ACS who visited the emergency room because of continuous chest pain and displayed transient ST segment elevation in their electrocardiogram were enrolled in the study. None of these patients had significant coronary artery disease and all had positive results in the provocation test. OCT examinations were performed for evaluation of vasospastic lesions.
Results:
Intraluminal thrombi and intimal erosion were found in 6 (33.3%) and 2 patients (10%), respectively. High-sensitivity C-reactive protein levels were significantly higher in patients with microthrombi (2.66 ± 3.33 mg/L) compared with those in patients without microthrombi (0.49 ± 0.30 mg/L; P = 0.022). Serum cardiac troponin-I levels were not significantly different between patients with or without microthrombi (2.37 ± 5.31 ng/mL vs. 1.45 ± 4.68 ng/mL; P = 0.704). Other parameters, including creatinine kinase-myocardial band isoenzyme, total cholesterol, pain duration, residual stenosis, lesion length, and coronary risk factors, were not significantly different between the 2 groups.
Conclusion:
In patients with vasospasm-induced ACS, microthrombi with or without intimal erosion are major abnormal morphologic findings of OCT examinations. However, further large-scale studies are required for validation.
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