OCT-based diagnosis and management of STEMI associated with intact fibrous cap

Francesco Prati, Shiro Uemura, Geraud Souteyrand, Renu Virmani, Pascal Motreff, Luca Di Vito, Giuseppe Biondi-Zoccai, Jonathan Halperin, Valentin Fuster, Yukio Ozaki, Jagat Narula

Research output: Contribution to journalReview articlepeer-review

158 Citations (Scopus)


In autopsy studies, at least 25% of thrombotic coronary occlusions are caused by plaque erosion in which thrombus often overlies atherosclerotic plaque without evident disruption of the fibrous cap. We performed optical coherence tomography imaging after aspiration thrombectomy and identified plaque erosion as the cause in 31 patients presenting with ST-segment elevation myocardial infarction. Plaque erosion was identified when the fibrous cap of the culprit lesion was intact. Based on clinical criteria, 40% of patients with subcritically occlusive plaque were treated with dual antiplatelet therapy without percutaneous revascularization (group 1), and the remaining 60% of patients underwent angioplasty and stenting (group 2). At a median follow-up of 753 days, all patients were asymptomatic, regardless of stent implantation. These observations support an alternative treatment strategy for patients with acute coronary events and optical coherence tomography-verified intact fibrous cap (or plaque erosion), where nonobstructive lesions might be managed without stenting.

Original languageEnglish
Pages (from-to)283-287
Number of pages5
JournalJACC: Cardiovascular Imaging
Issue number3
Publication statusPublished - 03-2013

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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