Utility of optical coherence tomography in acute coronary syndromes

Area of Science:

• Cardiovascular Medicine
• Medical Imaging
• Interventional Cardiology

Background:

• Histopathological studies identified plaque rupture, erosion, and calcified nodules as primary causes of acute coronary syndromes (ACS).
• Less common ACS etiologies include spontaneous coronary artery dissection, spasm, and embolism.
• Intravascular imaging modalities have corroborated these histopathological findings.

Purpose of the Study:

• To review clinical studies employing high-resolution intravascular optical coherence tomography (OCT) for assessing culprit plaque morphology in ACS.
• To discuss the application of intravascular OCT in guiding effective treatment strategies for ACS patients.
• To explore the potential for culprit lesion-based treatment using percutaneous coronary intervention (PCI).

Main Methods:

• Systematic review of clinical studies utilizing intravascular optical coherence tomography (OCT).
• Analysis of OCT-derived data on culprit plaque characteristics in patients with ACS.
• Evaluation of treatment outcomes based on OCT findings and subsequent interventions.

Main Results:

• Plaque rupture, erosion, and calcified nodules are consistently identified as the most frequent substrates for ACS via intravascular imaging.
• OCT provides high-resolution visualization of plaque morphology, aiding in the identification of the culprit lesion.
• OCT findings can inform percutaneous coronary intervention (PCI) strategies for improved patient management.

Conclusions:

• Intravascular OCT is a valuable tool for characterizing culprit lesions in ACS.
• OCT-guided treatment, including lesion-specific PCI, holds promise for optimizing ACS management.
• Further research should focus on integrating OCT findings into routine clinical practice for ACS.