Abstract 1989: Optical Coherence Tomography In Patients With Acute Coronary Syndromes. Increased Local Inflammatory Activation In Ruptured Plaques With Thin Fibrous Cap
Introduction: The identification of high-risk plaques cannot be performed by a single method, as several morphological and functional characteristics of the plaques need to be identified. We therefore investigated a possible correlation between local inflammatory activation, assessed by intracoronary thermography (ICT) and morphological characteristics of the plaques, by optical coherence tomography (OCT) in the culprit lesions of pts with ACS.
Methods: We included 24 pts (17 men, 7 women, mean ages 56±8 years) with ACS. OCT and ICT measurements were performed before pre-dilatation of the culprit lesion. Temperature difference (DT) was defined as the temperature of the CL minus the temperature of the proximal vessel wall. Minimal thickness of the fibrous cap (mTFC) and the incidence of ruptured fibrous plaque and intraluminal thrombus were analyzed by OCT. Finally, the CL was treated according to the operator’s discretion.
Results: We examined 24 CL. Fifteen CL (62.5%) had increased DT (DT≥0.05°C) and 9 CL (37.5%) had low DT (<0.05°C). mTFC was thinner in CL with increased DT compared to CL with low DT (61±13 vs. 207±78μm, p<0.01). Twelve ruptured fibrous caps were found in CL with high DT (80%, 12 out of 15), and 3 ruptured caps in the group with low DT (33%, 3 out of 9, p=0.06). The incidence of intraluminal thrombus was similar between CL with increased and low DT (82% vs. 77%, p=0.99).
Conclusions: In pts with ACS, CL with increased local temperature have thinner fibrous caps and are more often ruptured, compared to those with low temperature. Moreover, the incidence of intraluminal thrombus is not related to plaque temperature. The combination of OCT with ICT may provide further information for the identification of ‘high-risk’ plaques, which need to be more aggressively treated.