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J Am Coll Cardiol, 2007; 50:933-939, doi:10.1016/j.jacc.2007.04.082 (Published online 20 August 2007).
© 2007 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: ATHEROMA MORPHOLOGY

Assessment of Culprit Lesion Morphology in Acute Myocardial Infarction

Ability of Optical Coherence Tomography Compared With Intravascular Ultrasound and Coronary Angioscopy

Takashi Kubo, MD, PhD, Toshio Imanishi, MD, PhD, Shigeho Takarada, MD, PhD, Akio Kuroi, MD, Satoshi Ueno, MD, Takashi Yamano, MD, Takashi Tanimoto, MD, Yoshiki Matsuo, MD, PhD, Takashi Masho, MD, Hironori Kitabata, MD, Kazushi Tsuda, MD, PhD, Yoshiaki Tomobuchi, MD, PhD and Takashi Akasaka, MD, PhD*

Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.

Manuscript received December 20, 2006; revised manuscript received April 12, 2007, accepted April 17, 2007.

* Reprint requests and correspondence: Dr. Takashi Akasaka, Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan. (Email: akasat{at}wakayama-med.ac.jp).

Objectives: The aim of the present study was to evaluate the ability of optical coherence tomography (OCT) for assessment of the culprit lesion morphology in acute myocardial infarction (AMI) in comparison with intravascular ultrasound (IVUS) and coronary angioscopy (CAS).

Background: Optical coherence tomography is a new intravascular imaging method with a high resolution of approximately 10 µm. This may allow us to assess the vulnerable plaques in detail in vivo.

Methods: We enrolled 30 patients with AMI, and analyzed the culprit lesion by OCT, CAS, and IVUS.

Results: The average duration from the onset of symptom to OCT imaging was 3.8 ± 1.0 h. The incidence of plaque rupture observed by OCT was 73%, and it was significantly higher than that by CAS (47%, p = 0.035) and IVUS (40%, p = 0.009). Furthermore, OCT (23%) was superior to CAS (3%, p = 0.022) and IVUS (0%, p = 0.005) in the detection of fibrous cap erosion. The intracoronary thrombus was observed in all cases by OCT and CAS, but it was identified in 33% by IVUS (vs. OCT, p < 0.001). Only OCT could estimate the fibrous cap thickness, and it was 49 ± 21 µm. The incidence of thin cap fibroatheroma (TCFA) was 83% in this population by OCT.

Conclusions: Optical coherence tomography is a feasible imaging modality in patients with AMI and allows us to identify not only plaque rupture, but also fibrous cap erosion, intracoronary thrombus, and TCFA in vivo more frequently compared with conventional imaging techniques.

Abbreviations and Acronyms
  AMI = acute myocardial infarction
  CAS = coronary angioscopy
  IVUS = intravascular ultrasound
  OCT = optical coherence tomography
  TCFA = thin cap fibroatheroma
  TIMI = Thrombosis In Myocardial Infarction


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