Optical coherence tomography imaging in acute myocardial infarction

Optical coherence tomography (OCT) is a high-resolution intravascular imaging modality able to visualize the micro-environment of the atheromatic plaque and assess intracoronary stents in great detail. As a result, OCT is a valuable research tool for examining the role of morphological characteristics of atheromatic plaque in the progression of coronary artery disease and plaque destabilization, which lead to the clinical manifestation of acute coronary syndromes. Several OCT studies have focused on expanding the current understanding of the pathomechanisms of acute myocardial infarction. Moreover, as OCT is being increasingly used in clinical practice, potential clinical applications of OCT in myocardial infarction are emerging. Despite the lack of established indications for OCT imaging in myocardial infarction thus far, OCT could be potentially of assistance in interventional guidance in several clinical scenarios such as culprit lesion identification, assessment of the underlying mechanisms of stent thrombosis, and guidance of local and systematic antithrombotic therapy. The current chapter summarizes the pathophysiological insights obtained by OCT imaging in acute myocardial infarction, and critically reviews potential areas of clinical application of this imaging modality in myocardial infarction.