Kubo T et al. (2007) Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. J Am Coll Cardiol 50: 933–939

Intravascular optical coherence tomography (OCT) is an optical analog of intravascular ultrasonography (IVUS)—the current standard invasive method for diagnosing coronary artery disease. OCT has a markedly higher resolution than IVUS, and can resolve microstructures of atherosclerotic plaques that are thought to be associated with plaque vulnerability, such as thin fibrous caps, lipid cores and intracoronary thrombi. To determine whether OCT is superior to IVUS and coronary angioscopy for the evaluation of atherosclerotic plaques, Kubo et al. enrolled 30 patients with acute myocardial infarction and used each modality to analyze the culprit lesions.

OCT imaging enabled fibrous cap disruption to be identified in more patients than did either IVUS (P = 0.009) or angioscopy (P = 0.035). The detection of fibrous cap erosion was also higher with OCT than with IVUS or angioscopy—OCT detected this characteristic in 23% of cases, while angioscopy detected erosion in only 3% of cases and IVUS was unable to detect erosion in any of the cases. Notably, OCT was the only modality that enabled the estimation of fibrous cap thickness, which in this study was a mean of 49 µm. Both OCT and angioscopy were significantly better than IVUS for intracoronary thrombus detection; OCT and angioscopy enabled the identification of this microstructure in all cases, whereas IVUS detected it in only 33% of patients.

OCT, therefore, seems to be a feasible and safe imaging modality that facilitates the detailed characterization of vulnerable plaques in patients with acute myocardial infarction.