title: OCT-Defined Morphological Characteristics of Coronary Artery Spasm Sites in Vasospastic Angina.
abstract: OBJECTIVE
  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.
authors: Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. Electronic address: sesim1989@gmail.com.
authors: Eun-Seok
authors: ES
authors: Shin
authors: Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors: Soe Hee
authors: SH
authors: Ann
authors: Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors: Gillian Balbir
authors: GB
authors: Singh
authors: Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors: Kyung Hun
authors: KH
authors: Lim
authors: Department of Cardiology, Keimyung University, Dongsan Medical Center, Daegu, South Korea.
authors: Hyuck-Jun
authors: HJ
authors: Yoon
authors: Department of Cardiology, Keimyung University, Dongsan Medical Center, Daegu, South Korea.
authors: Seung-Ho
authors: SH
authors: Hur
authors: Department of Cardiology, Kangwon National University, Chuncheon, South Korea.
authors: Ae-Young
authors: AY
authors: Her
authors: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
authors: Bon-Kwon
authors: BK
authors: Koo
authors: Department of Cardiovascular Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan.
authors: Takashi
authors: T
authors: Akasaka
mesh_terms: D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000473:pathology*; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000473:pathology*; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging / Q000473:pathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology*; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging / Q000473:pathology*; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D056910:Republic of Korea; D041623:Tomography, Optical Coherence
keywords: Prinzmetal angina; acute myocardial infarction; cardiac arrest; intravascular imaging; plaque erosion; plaque rupture