Abstract
BackgroundNon-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) are caused often by destabilization of non-flow limiting inflamed coronary artery plaques. 18F-fluorodeoxyglucose (FDG) uptake with positron emission tomography/computed tomography (PET/CT) reveals plaque inflammation, while intracoronary optical coherence tomography (OCT) reliably identifies morphological features of coronary instability, such as plaque rupture or erosion. We aimed to prospectively compare these two innovative biotechnologies in the characterization of coronary artery inflammation, which has never been attempted before.MethodsOCT and FDG PET/CT were performed in 18 patients with single vessel coronary artery disease, treated by percutaneous coronary intervention (PCI) with stent implantation, divided into 2 groups: NSTEMI/UA (n = 10) and stable angina (n = 8) patients.ResultsPlaque rupture/erosion recurred more frequently [100% vs 25%, p = 0.001] and FDG uptake was greater [TBR median 1.50 vs 0.87, p = 0.004] in NSTEMI/UA than stable angina patients. FDG uptake resulted greater in patients with than without plaque rupture/erosion [1.2 (0.86–1.96) vs 0.87 (0.66–1.07), p = 0.013]. Among NSTEMI/UA patients, no significant difference in FDG uptake was found between ruptured and eroded plaques. The highest FDG uptake values were found in ruptured plaques, belonging to patients with NSTEMI/UA. OCT and PET/CT agreed in 72% of patients [p = 0.018]: 100% of patients with plaque rupture/erosion and increased FDG uptake had NSTEMI/UA.ConclusionFor the first time, we demonstrated that the correspondence between increased FDG uptake with PET/CT and morphology of coronary plaque instability at OCT is high.
Highlights
Acute coronary syndromes (ACS) represent one of the main causes of death worldwide
Out of 200 patients initially screened for enrolment, 35 patients (28 with Non-ST-elevation myocardial infarction (NSTEMI)/unstable angina (UA) and 7 with stable angina) refused to undergo positron emission tomography/computed tomography (PET/CT) scan
One hundred and seven patients were excluded for various reasons: 20 patients (14 with NSTEMI/UA and 6 with stable angina) because of optical coherence tomography (OCT) imaging failure, 55 patients (25 with NSTEMI/UA and 30 with stable angina) due to presence of multivessel coronary artery disease, and 32 patients (11 with NSTEMI/UA and 21 with stable angina) because they underwent balloon dilation of coronary artery before OCT assessment
Summary
Acute coronary syndromes (ACS) represent one of the main causes of death worldwide. While in stable coronary artery disease (CAD) myocardial ischemia worsens with growing stenosis severity, in most cases of ACS rupture or erosion occur at the site of non-flow limiting coronary artery plaques. Optical Coherence Tomography (OCT) currently represents the most promising invasive imaging technique to characterize coronary artery plaques, thanks to its capability to discriminate between smooth fibrous cap, plaque rupture or erosion with or without macrophage infiltration [4]. By performing OCT, it has been recently demonstrated that patients with ACS, having plaque rupture as mechanism of coronary instability, have a worse prognosis when compared with those having an intact fibrous cap. 18F-fluorodeoxyglucose (FDG) uptake with positron emission tomography/computed tomography (PET/CT) reveals plaque inflammation, while intracoronary optical coherence tomography (OCT) reliably identifies morphological features of coronary instability, such as plaque rupture or erosion. OCT and PET/CT agreed in 72% of patients [p = 0.018]: 100% of patients with plaque rupture/erosion and increased FDG uptake had NSTEMI/UA. Conclusion For the first time, we demonstrated that the correspondence between increased FDG uptake with PET/CT and morphology of coronary plaque instability at OCT is high
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