Serial volumetric assessment of coronary fibroatheroma by optical frequency domain imaging: insights from the TROFI trial

Aims

Coronary lesions precursors of acute events remain elusive, since they undergo continuous changes and their temporal changes are not very well-characterized. In natural history studies, optical frequency domain imaging (OFDI) has been used only to assess fibroatheromas as a 2D structure and sometimes in a single frame fashion. We aim at describing the serial volumetric modifications of the fibrous cap (FC) of the fibroatheromas as determined by OFDI over a 6-month follow-up period.

Methods and results

In 49 patients, OFDI investigation was performed following treatment of culprit lesion and at 6-month follow-up in patients with ST-segment elevation myocardial infarction (STEMI). A fully automatic volumetric quantification of FC was done in all lipid-containing frames of non-culprit lesions in the infarct related artery. These lesions were matched at baseline and 6-month follow-up. A total of 58 non-culprit lipid rich lesions (34 TCFAs and 24 thick-cap fibroatheroma [ThCFA]) were found in 34 patients at baseline. Overall, there was a FC volume decrease of 1.57 (Inter-quartile Range [IQR] -4.13 to 0.54) mm3 at 6-months. 27% of the lesions changed their phenotype over time (TCFA or ThCFA). TCFAs that became ThCFAs at follow-up had smaller mean and maximal FC as compared with lesions that remained TCFAs (P = 0.01 for both).

Conclusions

Non-culprit fibroatheromas located in the infarct related artery of patients with STEMI had a volumetric reduction of the FC after 6-month follow-up. Quantitative FC assessment was able to differentiate high-risk lesions that became ThCFAs. There was a considerable change of plaque phenotype (TCFAs or ThCFAs) over time.