Author + information
- Received August 23, 2014
- Revision received March 10, 2015
- Accepted March 19, 2015
- Published online September 1, 2015.
- Eun-Seok Shin, MD, PhD∗∗ (, )
- Soe Hee Ann, MD∗,
- Gillian Balbir Singh, MBChB∗,
- Kyung Hun Lim, MD∗,
- Hyuck-Jun Yoon, MD, PhD†,
- Seung-Ho Hur, MD, PhD†,
- Ae-Young Her, MD, PhD‡,
- Bon-Kwon Koo, MD, PhD§ and
- Takashi Akasaka, MD, PhD‖
- ∗Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
- †Department of Cardiology, Keimyung University, Dongsan Medical Center, Daegu, South Korea
- ‡Department of Cardiology, Kangwon National University, Chuncheon, South Korea
- §Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
- ‖Department of Cardiovascular Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan
- ↵∗Reprint requests and correspondence:
Dr. Eun-Seok Shin, Department of Cardiology, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 682-714, South Korea.
Objectives The aim of this study was to define the morphological features of coronary artery spasm sites using optical coherence tomography (OCT) in patients with vasospastic angina (VSA).
Background Plaque characteristics at coronary artery spasm sites have not been investigated systematically.
Methods Sixty-nine consecutive patients (80 spasm sites) presenting with VSA who underwent OCT imaging were included in this study. Fibrous cap disruption was identified by the discontinuation of fibrous cap with or without intraplaque cavity formation. OCT-defined erosion was established by the presence of thrombus with or without lumen irregularity overlying an intact fibrous cap on multiple adjacent OCT frames. Other morphological features such as the absence of thrombus with or without lumen irregularity and those not in the previously mentioned criteria were also documented.
Results Plaque was seen on OCT in 79 of the 80 spasm sites. Fibrous cap disruption was detected at 3 sites (4%). OCT-defined erosion was observed at 21 spasm sites (26%). Thrombus with lumen irregularity was observed in 20 sites, whereas 1 site had thrombus without lumen irregularity. Lumen irregularity without thrombus was observed at 49 spasm sites (61%). Spontaneous spasm was seen more frequently in patients with acute myocardial infarction and out-of-hospital cardiac arrest than in patients without these conditions (50.0% vs. 19.3%, p = 0.025).
Conclusions Our results show that OCT-defined erosion at spasm sites occurred in more than one-fourth of patients in this study. Luminal irregularity was observed in nearly two-thirds of the patients without overlying thrombus. These findings suggest the potential role of antiplatelet therapy in VSA.
- acute myocardial infarction
- cardiac arrest
- intravascular imaging
- plaque erosion
- plaque rupture
- Prinzmetal angina
Dr. Akasaka has received research grants from Abbott Vascular Japan, St. Jude Medical Japan, Goodman Inc., Terumo Inc., and Daiichi-Sankyo Pharmaceutical Co.; and has served on the advisory boards of St. Jude Medical Japan and Terumo Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 23, 2014.
- Revision received March 10, 2015.
- Accepted March 19, 2015.
- 2015 American College of Cardiology Foundation