Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions

Abstract

This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.

Optical coherence tomography‐defined plaque vulnerability in relation to functional stenosis severity stratified by fractional flow reserve and quantitative flow ratio

“…Median follow-up days of ACS non-culprit lesions were 10 days. [6][7][8][9][10][11][12][13] A representative case is shown in Figure 1. All lesions were divided into FFR and QFR tertiles, as previous studies.…”

“…6 Optical coherence tomography (OCT) can detect high-risk anatomical plaque features that have been established as pathogenically fundamental in acute coronary syndrome (ACS) and sudden cardiac death. [7][8][9] Our group recently reported that the development of OCTdefined thin-cap fibroatheroma (TCFA) was associated with physiological severity as represented by the FFR in intermediate-to-severe stenoses. 10 A recent study also showed that not only the FFR but also microvascular dysfunction as represented by the IMR is an independent predictor of the presence of OCT-defined TCFA.…”

Guidelines for the management of myocardial infarction/injury with non-obstructive coronary arteries (MINOCA): a position paper from the Dutch ACS working group

“…Near-infrared spectroscopy-intravascular ultrasound (IVUS) may help to quantify the lipid content of the coronary plaque and could potentially be an important tool to predict future events. Besides, this imaging modality could possibly distinguish whether the MINOCA event is caused by a vulnerable plaque that has ruptured or whether CAD is absent [21]. However, data on intravascular imaging in MINOCA patients is still sparse.…”

Predictive value of the QFR in detecting vulnerable plaques in non-flow limiting lesions: a combined analysis of the PROSPECT and IBIS-4 study

“…However, in these studies the positive predictive value of the studied invasive imaging modalities in predicting MACE was low. Therefore their routine use to stratify risk in the clinical setting is currently not recommended [17]. Combination of plaque morphology and physiology, particularly estimation of the ESS using computational fluid dynamic analysis of intravascular imaging data seems to provide additional prognostic information and detection of vulnerable plaques with a positive predictive value that exceeds > 50% [11,18].…”