Role of Optical Coherence Tomography in Clinical Management of Myocardial Infarction with Nonobstructive Coronary Arteries

Overview

Journal J Geriatr Cardiol

Specialty Geriatrics

Date 2025 Feb 12

PMID 39935440

Authors

Kenichi Tani

Osamu Kurihara

Akihiro Shirakabe

Nobuaki Kobayashi

Masamichi Takano

Kuniya Asai

Affiliations

Soon will be listed here.

Abstract

Myocardial infarction without angiographic moderate to severe stenosis (> 50%) and any other related diagnosis on clinical presentation is defined as myocardial infarction with nonobstructive coronary arteries (MINOCA). Common causes of MINOCA working diagnosis includes plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, coronary thromboembolism, Takotsubo cardiomyopathy, and myocarditis. Clinical history, assay of myocardial enzymes, electrocardiogram, echocardiography, coronary angiography, and left ventriculography facilitate the initial diagnosis of MINOCA and reveal the underlying causes, while cardiovascular magnetic resonance and optical coherence tomography (OCT) are used to confirm the diagnosis. Although cardiovascular magnetic resonance is the gold standard noninvasive diagnostic tool for MINOCA, its ability to diagnose the cause and mechanism underlying this condition in the coronary arteries is limited because of its image resolution. Observational studies have demonstrated that OCT can be used to determine the underlying cause of MINOCA by investigating the characteristics of the culprit lesions and to predict the prognosis of the patients. In this article, we review the current diagnostic approach for MINOCA focusing on each imaging tool. Furthermore, we reevaluate the role of OCT in the clinical management of MINOCA. Identifying the cause of MINOCA through OCT might help select optimal and effective drug treatments and improve prognosis.

References

Beltrame J, Crea F, Kaski J, Ogawa H, Ong P, Sechtem U . International standardization of diagnostic criteria for vasospastic angina. Eur Heart J. 2015; 38(33):2565-2568. DOI: 10.1093/eurheartj/ehv351. View

Ibanez B, James S, Agewall S, Antunes M, Bucciarelli-Ducci C, Bueno H . 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European.... Eur Heart J. 2017; 39(2):119-177. DOI: 10.1093/eurheartj/ehx393. View

Fearon W, Kobayashi Y . Invasive Assessment of the Coronary Microvasculature: The Index of Microcirculatory Resistance. Circ Cardiovasc Interv. 2017; 10(12). DOI: 10.1161/CIRCINTERVENTIONS.117.005361. View

Sugiyama T, Yamamoto E, Fracassi F, Lee H, Yonetsu T, Kakuta T . Calcified Plaques in Patients With Acute Coronary Syndromes. JACC Cardiovasc Interv. 2019; 12(6):531-540. DOI: 10.1016/j.jcin.2018.12.013. View

Demirkiran A, Everaars H, Amier R, Beijnink C, Bom M, Gotte M . Cardiovascular magnetic resonance techniques for tissue characterization after acute myocardial injury. Eur Heart J Cardiovasc Imaging. 2019; 20(7):723-734. DOI: 10.1093/ehjci/jez094. View

Occhipinti G, Bucciarelli-Ducci C, Capodanno D . Diagnostic pathways in myocardial infarction with non-obstructive coronary artery disease (MINOCA). Eur Heart J Acute Cardiovasc Care. 2021; 10(7):813-822. DOI: 10.1093/ehjacc/zuab049. View

Panovsky R, Borova J, Pleva M, Feitova V, Novotny P, Kincl V . The unique value of cardiovascular magnetic resonance in patients with suspected acute coronary syndrome and culprit-free coronary angiograms. BMC Cardiovasc Disord. 2017; 17(1):170. PMC: 5490179. DOI: 10.1186/s12872-017-0610-6. View

Dai J, Xing L, Jia H, Zhu Y, Zhang S, Hu S . In vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction: a clinical, angiographical, and intravascular optical coherence tomography study. Eur Heart J. 2018; 39(22):2077-2085. DOI: 10.1093/eurheartj/ehy101. View

Lindahl B, Baron T, Erlinge D, Hadziosmanovic N, Nordenskjold A, Gard A . Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease. Circulation. 2017; 135(16):1481-1489. DOI: 10.1161/CIRCULATIONAHA.116.026336. View

10.

Prati F, Romagnoli E, Burzotta F, Limbruno U, Gatto L, La Manna A . Clinical Impact of OCT Findings During PCI: The CLI-OPCI II Study. JACC Cardiovasc Imaging. 2015; 8(11):1297-305. DOI: 10.1016/j.jcmg.2015.08.013. View

11.

Pirozzolo G, Seitz A, Athanasiadis A, Bekeredjian R, Sechtem U, Ong P . Microvascular spasm in non-ST-segment elevation myocardial infarction without culprit lesion (MINOCA). Clin Res Cardiol. 2019; 109(2):246-254. DOI: 10.1007/s00392-019-01507-w. View

12.

Ciliberti G, Seshasai S, Ambrosio G, Kaski J . Safety of intracoronary provocative testing for the diagnosis of coronary artery spasm. Int J Cardiol. 2017; 244:77-83. DOI: 10.1016/j.ijcard.2017.05.109. View

13.

Parwani P, Kang N, Safaeipour M, Mamas M, Wei J, Gulati M . Contemporary Diagnosis and Management of Patients with MINOCA. Curr Cardiol Rep. 2023; 25(6):561-570. PMC: 10188585. DOI: 10.1007/s11886-023-01874-x. View

14.

Wittstein I, Thiemann D, Lima J, Baughman K, Schulman S, Gerstenblith G . Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005; 352(6):539-48. DOI: 10.1056/NEJMoa043046. View

15.

Brezinski M, Tearney G, Bouma B, Izatt J, Hee M, Swanson E . Optical coherence tomography for optical biopsy. Properties and demonstration of vascular pathology. Circulation. 1996; 93(6):1206-13. DOI: 10.1161/01.cir.93.6.1206. View

16.

Tearney G, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra H . Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol. 2012; 59(12):1058-72. DOI: 10.1016/j.jacc.2011.09.079. View

17.

Thygesen K, Alpert J, Jaffe A, Chaitman B, Bax J, Morrow D . Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2018; 40(3):237-269. DOI: 10.1093/eurheartj/ehy462. View

18.

Friedrich M, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper L . Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardiol. 2009; 53(17):1475-87. PMC: 2743893. DOI: 10.1016/j.jacc.2009.02.007. View

19.

Araki M, Park S, Dauerman H, Uemura S, Kim J, Di Mario C . Optical coherence tomography in coronary atherosclerosis assessment and intervention. Nat Rev Cardiol. 2022; 19(10):684-703. PMC: 9982688. DOI: 10.1038/s41569-022-00687-9. View

20.

Roffi M, Patrono C, Collet J, Mueller C, Valgimigli M, Andreotti F . 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment.... Eur Heart J. 2015; 37(3):267-315. DOI: 10.1093/eurheartj/ehv320. View