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Clinical Predictors for Lack of Favorable Vascular Response to Statin Therapy in Patients With Coronary Artery Disease: A Serial Optical Coherence Tomography Study Covering our tracks – optical coherence tomography to assess vascular healing Optical coherence tomography versus intravascular ultrasound to evaluate coronary artery disease and percutaneous coronary intervention Assessment of the coronary calcification by optical coherence tomography A Survey on Coronary Atherosclerotic Plaque Tissue Characterization in Intravascular Optical Coherence Tomography Intravascular optical coherence tomography Volumetric characterization of human coronary calcification by frequency-domain optical coherence tomography Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation Optical coherence tomography and C-reactive protein in risk stratification of acute coronary syndromes Characteristics of abnormal post-stent optical coherence tomography findings in hemodialysis patients
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Clinical Trial2009 Jun;30(11):1348-55.

JOURNAL：Eur Heart J. Article Link

Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-ST-segment elevation acute coronary syndrome: an optical coherence tomography study

Tanaka A, Imanishi T, Kitabata H et al. Keywords: microcirculation; reperfusion; plaque; angioplasty; OCT

ABSTRACT

AIMS - Although some recent guidelines recommend an early invasive strategy for non-ST-segment elevation acute coronary syndrome (NSTEACS), several studies have failed to identify any benefit for very early intervention for NSTEACS. The no-reflow phenomenon may inhibit the expected benefit from very early recanalization for NSTEACS subjects. The aim of this study was to investigate whether optical coherence tomography (OCT) could predict no-reflow in patients with NSTEACS.

METHODS AND RESULTS - This study comprised 83 consecutive patients with NSTEACS who underwent OCT and successful emergent primary stenting. On the basis of post-stent TIMI flow, patients were divided into two groups: no-reflow group (n = 14) and reflow group (n = 69). Thin-cap fibroatheroma (TCFA) was defined as a plaque presenting lipid content for >90 degrees , and with thinnest part of the fibrous cap measuring <70 microm. Thin-cap fibroatheroma were more frequently observed in the no-reflow group than in the reflow group (50% vs. 16%, P = 0.005). The frequency of the no-reflow phenomenon increases according to the size of the lipid arc in the culprit plaque. Final TIMI blush grade also deteriorated according to the increase in the lipid arc. A multivariable logistic regression model revealed that lipid arc alone was an independent predictor of no-reflow (odds ratio 1.018; CI 1.004-1.033; P = 0.01).

CONCLUSION - Optical coherence tomography can predict no-reflow after percutaneous coronary intervention (PCI) in NSTEACS. The lipid contents of a culprit plaque may play a key role in damage to the microcirculation after PCI for NSTEACS. From our results, it is found that OCT is useful tool for stratifying risk for PCI for NSTEACS.
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