INTRACORONARY EXPLORATION IN ACUTE CORONARY SYNDROME BY OPTICAL COHERENCE TOMOGRAPHY (OCT): EXPERIENCE OF NORD FRANCHE-COMTE HOSPITAL

Purpose: We evaluated the impact of the thrombus burden measured by optical coherence tomography (OCT) on the occurrence of peri-procedural myocardial infarction among patients included undergoing percutaneous coronary intervention (PCI) in non ST elevation acute coronary syndrome. Methods: Prospective multicenter study including patients treated for NSTE-ACS (<72 h) undergoing PCI of the infarct related artery. OCT was performed before and after PCI. Thrombus burden was measured quantitatively by planimetry, and semi quantitatively by the OCT thrombus score. Secondary endpoints evaluated the correlation between the OCT characteristics of the infarct related artery and the volume of thrombus, post PCI outcome of the thrombus, and the impact of thrombus volume on fractional flow reserve (FFR) measured at the end of the procedure. Results: 20 patients aged 62?6 years from Nord Franche-comt? hospital were included. Thrombus was more frequently present on OCT (14 patients (69%)) than on angiography (6 patients (31%)). There was no significant difference in the loading dose of aspirin, P2Y12 inhibitors or GPIIb/IIIa inhibitors between groups. Type IVa MI occurred in 7 patients (33%). The presence of thrombus was not associated with periprocedural MI (5 (39%) vs 2 (18%) p=0.93). Mean thrombus volume evaluated either by planimetry or semi-quantitavely was not predictive of type IVa MI. The presence of a plaque erosion or a plaque rupture was correlated with the presence of thrombus. There was a strong correlation between the presence of thrombus pre PCI and the presence of tissue prolapse post PCI. The volume of thrombus was significantly correlated with the volume of tissue prolapse (p=0.03 and p=0.01), this suggests that tissue prolapse is at least partly composed of thrombus. The presence of thrombus and its volume measured pre PCI did not affect the functional outcome of the angioplasty post pci( FFR = 0.94?0.04 vs 0.93?0.04 p=0.51). Conclusion: OCT enables better visualization of thrombus than angiography in NSTE-ACS. In patients receiving optimal antiplatelet therapy, neither the presence nor the volume of thrombus impacts on the rate of periprocedural myocardial infarction. Thrombus burden as measured pre-PCI is correlated with post PCI intra-stent tissue protrusion, but does not influence the functional outcome of the angioplasty as measured by FFR.