The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)


Plaque burden influences accurate classification of fibrous cap atheroma by in vivo optical coherence tomography in a porcine model of advanced coronary atherosclerosis

EuroIntervention 2018;14:1129-1135 published online April 2018. DOI: 10.4244/EIJ-D-17-01028

1. Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; 2. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; 3. Department of Bioengineering, Imperial College London, London, United Kingdom; 4. Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA; 5. Cardiovascular Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; 6. Department of Cardiology, Pamukkale University, Denizli, Turkey; 7. National Heart and Lung Institute, Imperial College London, London, United Kingdom

Aims: In vivo validation of coronary optical coherence tomography (OCT) against histology and the effects of plaque burden (PB) on plaque classification remain unreported. We aimed to investigate this in a porcine model with human-like coronary atherosclerosis.

Methods and results: Five female Yucatan D374Y-PCSK9 transgenic hypercholesterolaemic minipigs were implanted with a coronary shear-modifying stent to induce advanced atherosclerosis. OCT frames (n=201) were obtained 34 weeks after implantation. Coronary arteries were perfusion-fixed, serially sectioned and co-registered with OCT using a validated algorithm. Lesions were adjudicated using the Virmani classification and PB assessed from histology. OCT had a high sensitivity, but modest specificity (92.9% and 74.6%), for identifying fibrous cap atheroma (FCA). The reduced specificity for OCT was due to misclassification of plaques with histologically defined pathological intimal thickening (PIT) as FCA (46.1% of the frames with histological PIT were misclassified). PIT lesions misclassified as FCA by OCT had a statistically higher PB than in other OCT frames (median 32.0% versus 13.4%; p<0.0001). Misclassification of PIT lesions by OCT occurred when PB exceeded approximately 20%.

Conclusions: Compared with histology, in vivo OCT classification of FCA had high sensitivity but reduced specificity due to misclassification of PITs with high PB.

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