Predicting Polyvascular Disease Using OCTA and OCT in Acute Coronary Syndrome
Overview
This study evaluated retinal microvascular changes via optical coherence tomography angiography (OCTA) and coronary plaque characteristics via optical coherence tomography (OCT) in acute coronary syndrome (ACS) patients to predict polyvascular disease (PVD). Findings suggest distinct retinal and coronary imaging markers differentiate ACS patients with PVD from those without, highlighting the potential of combined OCTA and OCT for early PVD detection.
Background
Polyvascular disease (PVD) involves atherosclerosis in two or more vascular beds and is associated with significantly increased cardiovascular morbidity and mortality. Despite its high-risk status, PVD is often underdiagnosed due to atypical presentations and limited clinical awareness. Retinal microvascular dysfunction, assessable by OCTA, may reflect systemic endothelial health and precede macrovascular events. Concurrently, OCT provides high-resolution coronary plaque characterization, offering a comprehensive approach to identifying PVD in ACS patients.
Data Highlights
The study retrospectively enrolled 311 ACS patients undergoing coronary angiography and OCT/OCT-IVUS imaging, with 238 lesions analyzable by OCT. OCTA imaging was completed in 177 patients. PVD was defined by ≥ 50% stenosis in ≥ 2 vascular beds detected by non-contrast enhanced magnetic resonance angiography (NCE-MRA). Imaging parameters included vessel density, foveal avascular zone metrics, and plaque morphology. Statistical analyses involved multivariable logistic regression to identify predictors of PVD.
Key Findings
ACS patients with PVD showed distinct retinal microvascular alterations on OCTA compared to those without PVD.
High-risk coronary plaque features were more prevalent in ACS patients with PVD as identified by OCT/IVUS imaging.
Retinal vessel density and foveal avascular zone metrics correlated with systemic polyvascular involvement.
Non-contrast enhanced MRA reliably identified stenosis in intracranial, carotid, and renal arteries to define PVD.
Clinical Implications
Integrating retinal OCTA with coronary OCT imaging offers a noninvasive method to detect microvascular and macrovascular changes indicative of polyvascular disease in ACS patients. Early identification of PVD through these imaging modalities may facilitate risk stratification and prompt initiation of comprehensive vascular management strategies. Clinicians should consider multimodal vascular imaging to improve diagnosis and treatment of high-risk patients.
Conclusion
The combined use of OCTA and OCT imaging reveals distinct vascular alterations in ACS patients with polyvascular disease, supporting their utility in early PVD detection. This approach may enhance clinical risk assessment and guide targeted interventions to improve cardiovascular outcomes.
References
Multiple sources (2023-2025) -- Utilizing Optical Coherence Tomography Angiography and Optical Coherence Tomography for the Prediction of Polyvascular Disease
