Comparison of morphologic findings obtained by optical coherence tomography in acute coronary syndrome caused by vasospasm and chronic stable variant angina

Abstract

This study used optical coherence tomography (OCT) to evaluate morphologic changes in vasospastic lesions, which can cause acute coronary syndrome (ACS) or chronic stable VA. Thirty-nine patients (52.4 ± 9.0 years, 33 males) with vasospasm-induced ACS who presented with chest pain and displayed transient ST segment elevation on electrocardiography were included in the ACS group. Forty-one patients (49.3 ± 7.7 years, 33 males) who presented with chronic stable variant angina were included in the VA group. The clinical characteristics and morphologic OCT results of the two groups were compared. There were no differences in baseline characteristics, including the proportions of hypertension, diabetes mellitus, and smoking, between the two groups. Intimal tear, erosion, and intra-luminal thrombi were more frequent in the ACS group than the VA group (P < 0.001, P < 0.001, and P = 0.006, respectively). High-sensitivity C-reactive protein level was higher in the ACS group than the VA group (1.33 ± 1.93 vs 0.48 ± 0.50 mg/l, P = 0.011). Maximal intima thickness of spastic segment (0.38 ± 0.06 vs 0.31 ± 0.05 mm, P < 0.001) was significantly greater in the ACS group than in the VA group. In patients with vasospasm-induced ACS, intimal tear, intimal erosion, and microthrombi are major abnormal morphologic findings of OCT compared with patients with chronic stable VA.

Angioscopic differences of coronary intima between diffuse and focal coronary vasospasm: Comparison of optical coherence tomography findings

“…Moreover, the OCT data supported the CAS findings; this indicates that focal CS was associated with a thicker intima-media layer with a lipid-rich plaque. Our findings are consistent with our previous IVUS report [11] or the findings of other previous reports [7,[28][29][30]. Focal CS is caused by local hyperreactivity to a generalized constrictor stimulus in mild atherosclerosis [25].…”

Two-dimensional myocardial deformation in coronary vasospasm-related Takotsubo cardiomyopathy

“…[ 26 , 27 ] Recently, some investigators found intimal erosion and lumen irregularities on optical coherence tomography in patients with CV and acute coronary syndromes. [ 28 , 29 ] Therefore, another form of atherosclerosis has been suggested in spastic arteries. [ 30 ] The structural changes in the epicardial coronary arteries can be visualized using intracoronary imaging techniques; however, microvascular changes can be assessed indirectly such as with hyperemic microvascular resistance.…”

Intravascular Ultrasound Observation of the Mechanism of No-Reflow Phenomenon in Acute Myocardial Infarction

“…It is possible that coronary a peripheral thrombus or the plaque composition causes occlusion, myocardial microcirculation disorders, cardiac syncope, and ischemia-reperfusion injury (e.g., freedom injury, vascular endothelial tissue injury, inflammatory cell infiltration, and myocardial edema) [ 23 , 24 ]. With the development of coronary and myocardial perfusion and coronary morphology evaluation tools, an increasing number of studies show that micro-thrombi (15 ~ 100μm) caused by unstable plaque ruptures in the intervention process play a very important role in the mechanism of myocardial reperfusion [ 25 , 26 ].…”