Coronary artery disease
Assessment of Coronary Arterial Plaque by Optical Coherence Tomography

https://doi.org/10.1016/j.amjcard.2005.11.035Get rights and content

The purpose of this study was to analyze the ability of optical coherence tomography (OCT) to identify coronary arterial plaque diagnosed by histologic examination. We examined 166 sections from 108 coronary arterial segments of 40 consecutive human cadavers (24 men and 16 women; mean age 74 ± 7 years). The plaque type was classified as fibrous (n = 43), fibrocalcific (n = 82), or lipid-rich (n = 41). The accuracy of OCT and intravascular ultrasound (IVUS) in characterizing the plaque type was studied, with the histologic consensus diagnosis serving as the gold standard. OCT, as well as IVUS, had high sensitivity and specificity for characterizing the different types of atherosclerotic plaque. OCT had a higher sensitivity for characterizing lipid-rich plaques than IVUS (85% vs 59%, p = 0.03). In conclusion, the high resolution of OCT permitted evaluation of lipid-rich plaques more accurately than IVUS.

Section snippets

Methods

We examined 166 sections from 108 coronary arterial segments of 40 consecutive human cadavers (24 men and 16 women; mean age 74 ± 7 years). The cause of death was coronary heart disease in 6 of these 40 cadavers (15%). Fibrous plaques were found by histologic examination in 43 (26%), fibrocalcific plaques in 82 (49%), and lipid-rich plaques in 41 (25%) of the 166 sections. The Ethics Committee of Kawasaki Medical School approved the study protocol, and each family provided written informed

Plaque differentiation

Table 1 presents the performance of OCT and IVUS compared with histologic diagnosis. OCT and IVUS showed high sensitivities and specificities for characterizing the different types of atherosclerotic plaque. OCT had higher sensitivity for characterizing lipid-rich plaques than IVUS (p = 0.03, Fisher’s exact test). The overall agreement between the OCT and histologic diagnosis for the OCT readers was high (κ = 0.86 to 0.88). The overall agreement between the IVUS and histologic diagnosis for the

Discussion

OCT, as well as IVUS, showed high sensitivity and specificity for characterizing fibrous and fibrocalcific plaques. However, 15 of 41 lipid-rich plaques were misclassified as fibrous plaque by IVUS. Few lipid-rich plaques were misclassified as fibrous or fibrocalcific plaques by OCT. Thus, OCT had a higher sensitivity for characterizing lipid-rich plaques than IVUS.

Previous IVUS studies on plaque composition, mainly performed in the early 1990s with 20- to 30-MHz transducers, showed that the

Acknowledgment

The investigators gratefully acknowledge the excellent assistance of all medical personnel in the pathologic laboratory.

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