Myocardial infarction with non-obstructive thrombus validated by optical coherence tomography.

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging

Background:

• Coronary angiography offers limited insight into the underlying pathology of acute coronary syndromes (ACS).
• Optical coherence tomography (OCT) provides detailed visualization of coronary atherosclerosis, thrombus formation, and plaque rupture, particularly in cases of myocardial infarction (MI) where conventional angiography is inconclusive.

Observation:

• A case series of six young patients (median age 31.5 years) with ACS was analyzed.
• Four patients presented with non-obstructive thrombus and were managed conservatively without stent implantation.
• Two patients underwent thrombus aspiration and balloon angioplasty, also foregoing stent implantation.

Findings:

• OCT imaging confirmed thrombus formation in all patients, with varying degrees of resolution observed on short-term follow-up (3-5 days).
• No invasive intervention was performed in four patients, while two received aspiration and balloon angioplasty.
• No adverse cardiac events were reported during a median follow-up of 5.5 months.

Implications:

• OCT is effective in visualizing thrombus in young ACS patients, including those with non-obstructive thrombus or post-intervention.
• A conservative medical management strategy appears safe and effective for selected young ACS patients, potentially obviating the need for stent implantation.