Role of optical coherence tomography in managing patients with ST elevation myocardial infarction

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Imaging

Background:

• Percutaneous coronary intervention (PCI) with stenting is the standard treatment for acute coronary syndrome (ACS) resulting from culprit lesion stenting.
• Plaque rupture is the predominant cause of ACS, but other pathologies like plaque erosion can also precipitate ACS.
• Non-obstructive lesions or alternative mechanisms may allow for conservative management strategies.

Observation:

• A case of acute coronary syndrome (ACS) was presented with symptoms suggestive of cardiac ischemia.
• Intracoronary imaging revealed plaque erosion as the underlying pathology, with no significant obstructive coronary artery disease.
• The patient's clinical presentation and imaging findings prompted consideration of non-invasive management.

Findings:

• The patient was successfully managed conservatively without the need for stenting.
• Plaque erosion was confirmed as the mechanism responsible for ACS in this case.
• The absence of an obstructive lesion supported the decision for conservative treatment.

Implications:

• This case underscores the critical role of intracoronary imaging in differentiating ACS etiologies.
• Accurate assessment of underlying pathology can identify ACS cases amenable to conservative management, avoiding unnecessary stenting.
• Integrating intracoronary imaging into ACS workup can personalize treatment strategies and potentially reduce procedural risks and healthcare costs.