OCT in MI Without Obstructive CAD

Oct 18, 2018
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Authors:
Opolski M, Spiewak M, Marczak M, et al.
Citation:
Mechanisms of Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease: Results From the Optical Coherence Tomography Study. JACC Cardiovasc Imaging 2018;Oct 17:[Epub ahead of print].
Summary By:
Bina Ahmed, MD, FACC

Study Questions:

What are the morphologic features of plaque using optical coherence tomography (OCT) among patients with myocardial infarction with nonobstructive coronary arteries (MINOCA)?

Methods:

Thirty-eight patients presenting with MI in the absence of obstructive coronary artery disease underwent OCT. In addition, 31 patients also underwent cardiac magnetic resonance (CMR) with late gadolinium-enhancement (LGE). Infarct-related artery (IRA) was identified by localization of ischemic-type LGE.

Results:

Mean age of the cohort was 62 ± 13 years, 55% were female, and 39% presented with ST-segment elevation. Plaque disruption and coronary thrombus were observed in nine patients (24%) and seven patients (18%), respectively. Sixteen of thirty-one patients (52%) undergoing CMR showed LGE. Ischemic-type LGE was present in seven patients (23%) and was more common in patients with versus without plaque disruption (50% vs. 13%, p = 0.053) and coronary thrombus (67% vs. 12%, p = 0.014). In the per-lesion analysis, the IRA showed significantly more plaque disruption (40% vs. 6%, p = 0.02), thrombus (50% vs. 4%, p = 0.014), and thin-cap fibroatheroma (70% vs. 30%, p = 0.03) than the non-IRA.

Conclusions:

Plaque disruption and thrombus are not uncommon in MI without obstructive coronary stenoses at angiography, and might be associated with the presence and location of ischemic-type myocardial injury on CMR. OCT may be valuable in identifying atherosclerotic etiology in individuals with MINOCA.

Perspective:

MINOCA is increasingly being seen in clinical practice. There has been a major effort to better understand the pathophysiology of this presentation. Limitations in studying this group have been due to the heterogeneous nature of the patients and challenges in defining findings on OCT. The current study adds to the growing body of literature suggesting that some type of plaque disruption is noted on OCT in approximately 40% of patients with MINOCA. Use of OCT and CMR can help identify those with MINOCA due to an atherosclerotic process allowing for more aggressive medical therapy for secondary prevention in this patient group. More research is needed to identify high-risk patients with MINOCA using noninvasive methods.

Clinical Topics: Acute Coronary Syndromes, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Magnetic Resonance Imaging, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Angiography, Atherosclerosis, Coronary Artery Disease, Coronary Stenosis, Diagnostic Imaging, Gadolinium, Ischemia, Magnetic Resonance Imaging, Myocardial Infarction, Myocardium, Plaque, Atherosclerotic, Secondary Prevention, Thrombosis, Tomography, Optical Coherence


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