OBJECTIVE Cholesterol crystals (CCs) are frequently found at the site of acute myocardial infarctions (AMIs), but the role of CCs in the onset of AMI remains unclear due to the lack of validated in vivo imaging tools. The aim of this study was to validate the ability of optical coherence tomography (OCT) to detect CCs and to compare the prevalence and distribution of CCs in patients with AMIs and stable angina pectoris. Approach and Results: CC assessment using OCT were compared with histopathology results in 45 coronary samples. We investigated 152 consecutive patients with AMIs and 41 patients with single vessel-diseased stable angina pectoris. Based on the presence of plaque ruptures (PR), AMI patients were divided into 2 groups: those with PR (n=112) and those without PR (n=40). CCs invading fibrous caps were defined as superficial-type CCs. A multivariable logistic regression analysis was performed to determine PR predictors. The sensitivity and specificity of OCT for detecting CCs were 68% and 92%, respectively. The prevalence of plaques with CCs was higher in the AMI with PR group (AMI with PR 81%, AMI without PR 48%, stable angina pectoris 39%, P<0.01). A multivariable logistic model showed that superficial-type CCs and thin-cap fibroatheromas were positive predictors for PR. CONCLUSIONS OCT has a high specificity and modest sensitivity for the detection of CCs. The combination of CCs invading fibrous cap and thin-cap fibroatheromas detected by OCT may better identify rupture-prone plaques.

中文翻译：

---

使用光学相干断层扫描技术检测体内胆固醇晶体的可行性和临床意义。

目的在急性心肌梗塞（AMI）部位经常发现胆固醇晶体（CC），但由于缺乏经过验证的体内成像工具，CC在AMI发作中的作用仍不清楚。这项研究的目的是验证光学相干断层扫描（OCT）检测CC的能力，并比较AMI和稳定型心绞痛患者的CC患病率和分布。方法和结果：比较了使用OCT进行的CC评估与45例冠状动脉样本的组织病理学结果。我们调查了152例连续的AMI患者和41例单血管病变的稳定型心绞痛患者。根据斑块破裂（PR）的存在，将AMI患者分为两组：PR组（n = 112）和无PR组（n = 40）。侵袭纤维帽的CC被定义为表面型CC。进行多变量logistic回归分析以确定PR预测因子。OCT检测CC的敏感性和特异性分别为68％和92％。PR组AMI患者中CCs斑块的患病率较高（AMI患者PR 81％，AMI患者PR 48％，稳定型心绞痛39％，P <0.01）。多变量logistic模型表明，浅表型CC和薄囊性纤维动脉瘤是PR的阳性指标。结论OCT对CC的检测具有很高的特异性和适度的敏感性。OCT检测到的侵袭性纤维帽和薄帽纤维化动脉瘤的CCs结合可以更好地识别易破裂斑块。PR组AMI患者中CCs斑块的患病率较高（AMI患者PR 81％，AMI患者PR 48％，稳定型心绞痛39％，P <0.01）。多变量logistic模型显示，浅表型CC和薄囊性纤维动脉瘤是PR的阳性指标。结论OCT对CC的检测具有很高的特异性和适度的敏感性。OCT检测到的侵袭性纤维帽和薄帽纤维化动脉瘤的CCs结合可以更好地识别易破裂斑块。PR组AMI患者中CCs斑块的患病率较高（AMI患者PR 81％，AMI患者PR 48％，稳定型心绞痛39％，P <0.01）。多变量logistic模型显示，浅表型CC和薄囊性纤维动脉瘤是PR的阳性指标。结论OCT对CC的检测具有很高的特异性和适度的敏感性。OCT检测到的侵袭性纤维帽和薄帽纤维化动脉瘤的CCs结合可以更好地识别易破裂斑块。