Morphological Findings in Typical Variant Angina Presenting as Acute Coronary Syndrome Using Optical Coherence Tomography

Park, Hwan Cheol; Choi, Sung Il; Lee, Jae-Ung; Kim, Soon-Gil; Shin, Jinho; Kim, Hyun‐Joong

doi:10.1111/joic.12060

Cited by 8 publications

(7 citation statements)

References 32 publications

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“…As stated it in our pilot study [15], these OCT findings strongly suggest that clinicians should be aware of possible underlying intimal damage, even when there are no significant fixed lesions in the coronary angiograms of patients with typical VA presenting as ACS. Despite the small size of the complex lesions of relatively low thrombogenic potential, the intra-luminal microthrombi, noted in 11 (28 %) patients in the ACS group, are significant in suggesting that they are characteristic of the pathobiologic process underlying ACS.…”

Section: Discussionmentioning

confidence: 75%

“…In a previous pilot study, microthrombi with or without intimal erosion were the major morphologic abnormal findings in OCT of patients with vasospasm-induced ACS [15]. The objective of the current study was to compare the morphologic findings obtained by OCT in coronary artery segments causing vasospasm in the patients who visited the emergency clinic presenting with ACS (ACS group) and those who attended the outpatient clinic in a stable state and were diagnosed with VA (VA group).…”

Section: Discussionmentioning

confidence: 95%

“…The OCT imaging technique has been described [15,18,19]. In brief, using an intravascular OCT M2X system (LightLab Imaging, Westford, MA, USA), an intravascular OCT catheter was inserted via a 7 Fr guiding catheter, replacing a 4 Fr catheter through the culprit spastic lesion after complete vasodilatation of the coronary artery by injection of a further 100-200 lg nitroglycerin in patients with positive results in the provocation test (Fig.…”

Section: Optical Coherence Tomographymentioning

confidence: 99%

“…OCT was performed as described previously if diagnostic CAG revealed no significant fixed lesion and a provocation test revealed coronary vasospasm [15].…”

Section: Study Populationmentioning

confidence: 99%

“…microthrombi with or without intimal tear, in patients with vasospastic angina presenting with ACS [15]. To test the hypothesis that the occurrence of an acute coronary event underlining coronary vasospasm is associated with an increased level of vulnerable plaque features, such as intimal tear or intraluminal thrombi, compared with stable chronic vasospasm, in the current study we assessed the morphologic characteristics of spastic segments in the culprit coronary artery, and compared the differences in intimal lesions between the two heterogeneous groups.…”

Section: Introductionmentioning

confidence: 98%

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

Park

Shin

Jeong

et al. 2014

Int J Cardiovasc Imaging

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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.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 95%

Section: Optical Coherence Tomographymentioning

confidence: 99%

“…OCT was performed as described previously if diagnostic CAG revealed no significant fixed lesion and a provocation test revealed coronary vasospasm [15].…”

Section: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

See 3 more Smart Citations

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

Park

Shin

Jeong

et al. 2014

Int J Cardiovasc Imaging

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Clinical efficacy of aspirin with identification of intimal morphology by optical coherence tomography in preventing event recurrence in patients with vasospasm-induced acute coronary syndrome

Lee

Park

Shin

2018

Int J Cardiovasc Imaging

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Using optical coherence tomography (OCT), we found that there were morphological differences in the coronary intima between patients with vasospasm-induced acute coronary syndrome (VACS) and those with stable variant angina. We investigated whether aspirin use would protect against chest pain recurrence in patients with VACS. A retrospective cohort study was performed. Patients with ST-segment elevation who were confirmed to have VACS by a provocation test were included. OCT was performed at the index event and when chest pain recurred to assess intimal morphology. Chest pain recurrence was defined as the first revisit to the emergency room with angina. Propensity score matching was performed between the aspirin and non-aspirin groups. For 48 months, 154 patients were followed (77 patients in each group). The baseline characteristics and OCT findings were well balanced between the two groups after propensity score matching. Myocardial infarction (17 vs. 3%, p = 0.003) and chest pain recurrence (26 vs. 9%, p = 0.006) occurred more frequently in the non-aspirin group than in the aspirin group. Multiple Cox regression analysis showed that aspirin use was a significant predictor of lower risk of myocardial infarction [hazard ratio (HR) 0.13; 95% confidence interval (CI) 0.03-0.61] and chest pain recurrence (HR 0.33; 95% CI 0.12-0.71) during the follow-up period, after adjustments for relevant covariates including OCT findings. The use of aspirin may have a preventive effect on myocardial infarction and chest pain recurrence in patients with VACS. Randomized controlled trials are necessary to confirm the result.

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Nonatherosclerotic Causes of Acute Coronary Syndrome: Recognition and Management

et al. 2014

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Acute coronary syndromes (ACS) frequently result from the rupture or erosion of a vulnerable coronary plaque, with associated intracoronary thrombosis. ACS also may occur in patients with angiographically normal coronary arteries. Some of these patients, however, still have angiographically silent underlying coronary artery disease. In this setting, subtle atherosclerotic changes frequently associated with unstable morphologic features or residual intracoronary thrombus may be detected with intracoronary imaging techniques. Nevertheless, other patients develop ACS as a result of nonatherosclerotic coronary artery disease (NA-CAD). ACS in patients with NA-CAD may be the consequence of coronary spasm or transient coronary embolic phenomena. In these patients, after the initial ischemic insult, late coronary angiography usually reveals normal epicardial coronary vessels. Kounis syndrome is a type of ACS generated by allergic reactions. Takotsubo cardiomyopathy is characterized by normal coronary arteries with a distinct pattern of transient left ventricular wall motion abnormalities. ACS also may occur in young patients following illicit drug use. Finally, spontaneous coronary artery dissection and intramural hematoma represent other etiologies of NA-CAD. In this review, we discuss current evidence regarding diagnostic and treatment strategies in patients presenting with ACS as a result of NA-CAD.

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Morphological Findings in Typical Variant Angina Presenting as Acute Coronary Syndrome Using Optical Coherence Tomography

Abstract: In patients with vasospasm-induced ACS, microthrombi with or without intimal erosion are major abnormal morphologic findings of OCT examinations. However, further large-scale studies are required for validation.

Cited by 8 publications

References 32 publications

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

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

Clinical efficacy of aspirin with identification of intimal morphology by optical coherence tomography in preventing event recurrence in patients with vasospasm-induced acute coronary syndrome

Nonatherosclerotic Causes of Acute Coronary Syndrome: Recognition and Management

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