This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2007.04.082v1 50/10/933    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kubo, T. Articles by Akasaka, T. Search for Related Content PubMed Articles by Kubo, T. Articles by Akasaka, T. Related Collections Related Article

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

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

Related Article

From Postmortem Characterization to the In Vivo Detection of Thin-Capped Fibroatheromas: The Missing Link Toward Percutaneous Treatment: What If Diogenes Would Have Found What He Was Looking For?

Patrick W. Serruys, Hector M. Garcia-Garcia, and Evelyn Regar
J. Am. Coll. Cardiol. 2007 50: 950-952. [Full Text] [PDF]

This article has been cited by other articles:

				F. Prati, E. Regar, G. S. Mintz, E. Arbustini, C. Di Mario, I.-K. Jang, T. Akasaka, M. Costa, G. Guagliumi, E. Grube, et al. Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis Eur. Heart J., November 4, 2009; (2009) ehp433v1. [Abstract] [Full Text] [PDF]

				C. M. Matter, M. Stuber, and M. Nahrendorf Imaging of the unstable plaque: how far have we got? Eur. Heart J., November 1, 2009; 30(21): 2566 - 2574. [Abstract] [Full Text] [PDF]

				H. G. Bezerra, M. A. Costa, G. Guagliumi, A. M. Rollins, and D. I. Simon Intracoronary Optical Coherence Tomography: A Comprehensive Review: Clinical and Research Applications J. Am. Coll. Cardiol. Intv., November 1, 2009; 2(11): 1035 - 1046. [Abstract] [Full Text] [PDF]

				A. Maehara, G. S. Mintz, and N. J. Weissman Advances in Intravascular Imaging Circ Cardiovasc Interv, October 1, 2009; 2(5): 482 - 490. [Full Text] [PDF]

				A. Hubalewska-Dydejczyk, T. Stompor, M. Kalembkiewicz, M. Krzanowski, R. Mikolajczak, A. Sowa-Staszczak, B. Tabor-Ciepiela, U. Karczmarczyk, B. Kusnierz-Cabala, and W. Sulowicz IDENTIFICATION OF INFLAMED ATHEROSCLEROTIC PLAQUE USING 123I-LABELED INTERLEUKIN-2 SCINTIGRAPHY IN HIGH-RISK PERITONEAL DIALYSIS PATIENTS: A PILOT STUDY Perit. Dial. Int., September 1, 2009; 29(5): 568 - 574. [Abstract] [Full Text] [PDF]

				H. M Garcia-Garcia, N. Gonzalo, E. Regar, and P. W Serruys Virtual histology and optical coherence tomography: from research to a broad clinical application Heart, August 15, 2009; 95(16): 1362 - 1374. [Full Text] [PDF]

				Min Pan, M.-H. Jiang, M.-F. Wei, Z.-H. Liu, W.-P. Jiang, H.-H. Geng, Z.-C. Cui, D.-L. Zhang, and J.-H. Zhu Association of Angiotensin-Converting Enzyme Gene 2350G>A Polymorphism With Myocardial Infarction in a Chinese Population Clinical and Applied Thrombosis/Hemostasis, August 1, 2009; 15(4): 435 - 442. [Abstract] [PDF]

				J. P. Williamson, A. L. James, M. J. Phillips, D. D. Sampson, D. R. Hillman, and P. R. Eastwood Quantifying tracheobronchial tree dimensions: methods, limitations and emerging techniques Eur. Respir. J., July 1, 2009; 34(1): 42 - 55. [Abstract] [Full Text] [PDF]

				H. Otake, J. Shite, J. Ako, T. Shinke, Y. Tanino, D. Ogasawara, T. Sawada, N. Miyoshi, H. Kato, B.-K. Koo, et al. Local Determinants of Thrombus Formation Following Sirolimus-Eluting Stent Implantation Assessed by Optical Coherence Tomography J. Am. Coll. Cardiol. Intv., May 1, 2009; 2(5): 459 - 466. [Abstract] [Full Text] [PDF]

				G. Guagliumi and M. Costa From a Foggy Sight to a Clear Vision J. Am. Coll. Cardiol. Intv., May 1, 2009; 2(5): 467 - 469. [Full Text] [PDF]

				S. S. Brar, A. Y.-J. Shen, V. Aharonian, P. Mansukhani, and J. Kim Reply. J. Am. Coll. Cardiol., December 16, 2008; 52(25): 2213 - 2213. [Full Text] [PDF]

				J. Waldeck, F. Hager, C. Holtke, C. Lanckohr, A. von Wallbrunn, G. Torsello, W. Heindel, G. Theilmeier, M. Schafers, and C. Bremer Fluorescence Reflectance Imaging of Macrophage-Rich Atherosclerotic Plaques Using an {alpha}v{beta}3 Integrin-Targeted Fluorochrome J. Nucl. Med., November 1, 2008; 49(11): 1845 - 1851. [Abstract] [Full Text] [PDF]

				Y.L. Gu, M.L. Fokkema, and F. Zijlstra The Emerging Role of Thrombus Aspiration in the Management of Acute Myocardial Infarction Circulation, October 28, 2008; 118(18): 1780 - 1782. [Full Text] [PDF]

				O C Raffel, T Akasaka, and I-K Jang Cardiac optical coherence tomography Heart, September 1, 2008; 94(9): 1200 - 1210. [Full Text] [PDF]

				J. Ohayon, G. Finet, A. M. Gharib, D. A. Herzka, P. Tracqui, J. Heroux, G. Rioufol, M. S. Kotys, A. Elagha, and R. I. Pettigrew Necrotic core thickness and positive arterial remodeling index: emergent biomechanical factors for evaluating the risk of plaque rupture Am J Physiol Heart Circ Physiol, August 1, 2008; 295(2): H717 - H727. [Abstract] [Full Text] [PDF]

				T. Kubo, T. Imanishi, H. Kitabata, A. Kuroi, S. Ueno, T. Yamano, T. Tanimoto, Y. Matsuo, T. Masho, S. Takarada, et al. Comparison of vascular response after sirolimus-eluting stent implantation between patients with unstable and stable angina pectoris a serial optical coherence tomography study. J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 475 - 484. [Abstract] [Full Text] [PDF]

				J. A. Ambrose In Search of the "vulnerable plaque": can it be localized and will focal regional therapy ever be an option for cardiac prevention? J. Am. Coll. Cardiol., April 22, 2008; 51(16): 1539 - 1542. [Abstract] [Full Text] [PDF]

				J. Sanz, P. R. Moreno, and V. Fuster The year in atherothrombosis. J. Am. Coll. Cardiol., March 4, 2008; 51(9): 944 - 955. [Full Text] [PDF]

				T. Kubo, T. Imanishi, S. Takarada, A. Kuroi, S. Ueno, T. Yamano, T. Tanimoto, Y. Matsuo, T. Masho, H. Kitabata, et al. Implication of plaque color classification for assessing plaque vulnerability a coronary angioscopy and optical coherence tomography investigation. J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 74 - 80. [Abstract] [Full Text] [PDF]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al. Highlights of the year in JACC 2007. J. Am. Coll. Cardiol., January 29, 2008; 51(4): 490 - 512. [Full Text] [PDF]

				P. W. Serruys, H. M. Garcia-Garcia, and E. Regar From Postmortem Characterization to the In Vivo Detection of Thin-Capped Fibroatheromas: The Missing Link Toward Percutaneous Treatment: What If Diogenes Would Have Found What He Was Looking For? J. Am. Coll. Cardiol., September 4, 2007; 50(10): 950 - 952. [Full Text] [PDF]