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

CORONARY INTERVENTIONS

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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