Clinical presentations and coronary plaque characteristics

Abstract

Despite a marked decline in cardiovascular mortality over the last several decades, ischemic coronary artery disease (CAD) still remains one of the leading causes of morbidity and mortality in the United States. This has prompted efforts to improve our understanding of the pathophysiology of CAD using in vivo imaging modalities. Due to its high resolution (10–15 μm), optical coherence tomography (OCT) enables an “optical biopsy” of the coronary artery wall, in vivo and in real time, and represents the modality of choice for the assessment of thin-cap fibroatheroma and other important microstructures such as neovascularization, macrophage density, microcalcifications, and cholesterol crystals. The present chapter focuses on the utility of intracoronary OCT, both as a diagnostic modality and as a research tool, in the detailed characterization of coronary atherosclerosis, in relation to the different clinical presentations (i.e., stable angina vs. acute coronary syndromes), and to the traditional cardiovascular risk factors (i.e., diabetes mellitus, dyslipidemia, smoking, hypertension) and other predisposing conditions (i.e., metabolic syndrome, chronic kidney disease).