Utilidad de la tomografía de coherencia óptica en el diagnóstico de pacientes inestables con estenosis coronarias no significativas

espanolIntroduccion y objetivos: A menudo resulta complejo diagnosticar a pacientes con infarto agudo de miocardio y estenosis coronarias no significativas en la coronariografia (MINOCA). En ocasiones, la angiografia muestra datos sugestivos de placa inestable, aunque no es infrecuente que estos pacientes acaben sin un diagnostico etiologico. La tomografia de coherencia optica (OCT) permite detectar placas vulnerables e inestables con rotura, erosion o trombo gracias a su elevada resolucion espacial, lo que podria implicar un cambio en el manejo de estos pacientes. El objetivo de este estudio es valorar la utilidad de la OCT para alcanzar un diagnostico final en casos seleccionados de MINOCA con alta sospecha de etiologia ateroesclerotica. Metodos: Registro de 27 pacientes desde septiembre de 2015 hasta enero de 2020 en los que se indica OCT en el contexto de sindrome coronario agudo y estenosis Resultados: La OCT evidencio la presencia de placa inestable con trombo, rotura de placa o erosion de placa en el 78% de los pacientes como causa del MINOCA. Los pacientes fueron predominantemente varones (89%), fumadores (63%), de mediana edad (53 anos de mediana), con poca carga de factores de riesgo y afectacion principalmente de la descendente anterior (74%). El 95% de los casos en que se detecto placa inestable fueron tratados con stent. La evolucion a medio plazo fue excelente. Conclusiones: En nuestra serie de pacientes con MINOCA y alta sospecha de causa ateroesclerotica, la OCT resulto ser una tecnica util para identificar la etiologia de la mayoria de ellos, lo que permitio adoptar una estrategia terapeutica mas especifica. EnglishIntroduction and objectives: The final diagnosis of a myocardial infarction with non-obstructive coronary arteries (MINOCA) is often hard to achieve. Angiographic findings may be suggestive of the presence of unstable plaques although it is common to discharge patients without an etiologic diagnosis. The high spatial resolution provided by the optical coherence tomography (OCT) allows the detection of vulnerable and unstable coronary plaques that are prone to rupture, erosion, and thrombi which may lead to more targeted individual therapies. The objective of this study is to assess the utility of OCT when achieving an etiologic diagnosis in selected patients with MINOCA and high clinical suspicion of atherosclerotic etiology. Methods: Registry of 27 patients recruited between September 2015 and January 2020 admitted to a single tertiary hospital with acute coronary syndrome and non-significant stenosis in the coronary angiography who underwent OCT. The baseline data of the study population, the angiographic and OCT findings, treatment and follow-up information were all collected. Results: The OCT imaging showed evidence of unstable plaques (thrombus, plaque erosion or plaque rupture) in 78% of patients, which lead to an etiologic diagnosis of MINOCA. Patients were predominantly males (89%), smokers (63%), middle-aged (median 53 years old) and with a low cardiovascular risk burden. The left anterior descending coronary artery was the most frequently compromised vessel (74%) and 95% of patients ended up receiving coronary stents. The mid-term follow-up was excellent. Conclusions: In our study, OCT imaging proved to be a valuable tool to achieve an etiologic diagnosis in a large proportion of selected patients with MINOCA which, as a result could lead to more specific and individualized treatments.