Author + information
- Sharath Kumar,
- Sang-Wook Kim,
- Jee Eun Kwon,
- Wang-Soo Lee,
- Joon Hwa Hong,
- Eun Young Kim,
- Kwang Je Lee,
- Chee Jeong Kim,
- Dai Yun Cho and
- Tae Ho Kim
We used Optical Coherence tomography (OCT) to evaluate the thrombus (TH) burden, Thin-capped fibroatheroma (TCFA) and their correlates in pts with acute coronary syndrome (ACS).
In 64 pts with ACS, the coronary angiographic thrombus grade (TIMI grade) was evaluated and compared to the pre-thrombectomy OCT thrombus score. The Thrombus score was evaluated (by a scoring system devised by Prati and coworkers) before thrombectomy. Thin-capped fibroatheroma (TCFA) on OCT were defined as those with fibrous cap thickness less than 65 μm and a large underlying lipid core.
OCT images were suitable for thrombus evaluation in 59 pts and 51% (30/59) of the culprit lesions contained TCFA. Plaque rupture was observed in 32 pts (54.2%) and plaque erosion in 5 pts (8.5%). There was no correlation between angiographic TH grading and OCT TH score (r=0.075, p=0.575). In addition, OCT detected TH in 14 pts without angiographic-visible thrombus. Pts with TCFA had a higher OCT TH score (p=0.043) and a longer lesion length (p=0.026). However, minimal lumen area and vessel size were similar in both groups (p=0.161, and p=0.773, respectively). There was no correlation between the time of presentation, diabetes and smoking status with OCT TH burden. Red TH were observed in 43.6% (24/55) of pts and in 46.6% (14/30) with TCFA. Patients with a red TH had a higher OCT thrombus score than those with a white TH. (13.96±11.93 vs. 39.50±14.81, p<0.0001). Importantly, the presence of a red TH correlated with microvessels in the culprit lesion (r=0.404, p=0.002) and macrophage accumulation (r=0.614, p<0.0001).
Presence of TCFA predicted a larger thrombus burden, and a higher OCT Thrombus burden predicted a red thrombus with prominent inflammation.
|Minimal luminal area (mm2)||2.16±1.47||2.79±1.84||0.161|
|Lesion length (mm)||19.75±8.40||14.96±6.80||0.026|
|Distal reference lumen area (mm2)||7.59±2.95||7.36±3.00||0.773|
|TIMI thrombus grade||1.861.50||1.761.63||0.817|
|OCT thrombus score||28.33±19.29||18.26±16.60||0.043|
|Thrombus type (White/Red)||16/14||15/8||0.201|