Dual quantitative coronary angiography accurately quantifies intracoronary thrombotic burden in patients with acute coronary syndrome: Comparison with optical coherence tomography imaging Rocco Vergallo a,1 , Italo Porto a,b,1 , Giovanni Luigi De Maria c , Domenico D'Amario a , Gianmarco Annibali a , Mattia Galli a , Stefano Migliaro a , Giorgio Buccimazza a , Cristina Aurigemma a , Antonio Maria Leone a , Giampaolo Niccoli a , Rajesh Kharbanda c , Francesco Burzotta a , Bernard D. Prendergast c , Keith M. Channon c , Carlo Trani a , Adrian P. Banning c , Filippo Crea a, ⁎ a Fondazione Policlinico A. Gemelli IRCCS – Università Cattolica Sacro Cuore, Rome, Italy b IRCCS Ospedale Policlinico San Martino, Genova c Università di Genova, Cardiovascular Unit, Department of Internal Medicine and Specialties (DIMI) abstract article info Article history: Received 23 July 2018 Received in revised form 22 October 2018 Accepted 18 April 2019 Available online xxxx Background: Dual quantitative coronary angiography (QCA) has been recently tested for assessment of intracoronary thrombus volume in experimental models. The present study aimed to validate dual QCA in vivo for the assessment of thrombus burden by exploring the correlations between dual QCA-thrombus volume and optical coherence tomography (OCT)-derived indices of thrombotic burden. Methods and results: Fifty-one patients with ACS and angiographic evidence of thrombus undergoing OCT of the culprit lesion before stenting were included. Dual QCA-thrombus volume was calculated as difference between edge-detection and video-densitometry area functions along the target segment. Culprit lesion was categorized using the Ambrose's and AHA/ACC angiographic classifications. Thrombus volume (mean thrombus area × thrombus length), thrombus burden [(mean thrombus area/mean lumen area) x100] and Prati thrombus score (number of quadrants with thrombus) were measured by OCT, and the presence of plaque rupture (PR) or intact fibrous cap (IFC) was assessed. Dual QCA-thrombus volume correlated significantly with OCT- thrombus volume (R = 0.791), thrombus burden (R = 0.767) and Prati thrombus score (R = 0.600) (all p b 0.001). Dual-QCA thrombus volume was significantly higher in patients with PR compared with those with IFC (3.48 mm 3 [1.45–11.26] vs. 1.69 mm 3 [0.09–5.02], p = 0.013). Compared with IFC, PR showed higher prevalence of eccentric type II Ambrose lesion (41.7% vs. 7.4%, p = 0.004), complex B2/C lesion (87.5% vs. 55.6%, p = 0.012), and heavy calcification (29.2% vs. 3.7%, p = 0.013). Conclusions: Dual QCA analysis appears to be a promising tool for quantification of intracoronary thrombus in vivo. This novel methodology may be useful to guide intracoronary thrombus removal during percutaneous coronary intervention and to aid prognostic stratification in patients with ACS. © 2019 Elsevier B.V. All rights reserved. Keywords: Thrombus Acute coronary syndrome Quantitative coronary angiography Optical coherence tomography Plaque rupture Intact fibrous cap 1. Introduction Coronary thrombosis caused by plaque rupture (PR) or erosion is the most frequent underlying mechanism of acute coronary syndromes (ACS) and sudden cardiac death [1,2]. A large coronary thrombus bur- den (TB) is associated with higher rates of distal embolization, stent thrombosis, and long-term adverse cardiac events [3,4]. Pharmacologi- cal and mechanical strategies are routinely used with the aim of reduc- ing TB and minimizing its adverse effects [5–9]. An accurate quantification of the TB is therefore pivotal for understanding the path- ophysiology, predicting prognosis, and optimizing coronary interven- tions in patients with ACS. Angiographic thrombus grading scales, such as the Thrombolysis In Myocardial Infarction (TIMI) thrombus grading [10] and its simplified version proposed by Sianos et al. [4], are commonly used to estimate coronary TB. However, these analyses are notoriously subjective and have poor sensitivity. A novel method of quantitative coronary angiographic (QCA) analysis, based on both International Journal of Cardiology xxx (xxxx) xxx Abbreviations: QCA, quantitative coronary angiography; OCT, optical coherence tomography; ACS, acute coronary syndrome; STEMI, ST-segment elevation myocardial in- farction; TB, thrombus burden; PR, plaque rupture; IFC, intact fibrous cap. ⁎ Corresponding author at: Department of Cardiovascular and Thoracic SciencesPoliclinico Universitario A Gemelli IRCCS Catholic University of the Sacred Heart Largo Agostino Gemelli, 8 – 00168, Rome, Italy E-mail addresses: italo.porto@gmail.com (I. Porto), filippo.crea@unicatt.it, filippo.crea@unicatt.it (F. Crea). 1 The first two authors contributed equally to this work. IJCA-27626; No of Pages 7 https://doi.org/10.1016/j.ijcard.2019.04.060 0167-5273/© 2019 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard Please cite this article as: R. Vergallo, I. Porto, G.L. De Maria, et al., Dual quantitative coronary angiography accurately quantifies intracoronary thrombotic burden in pati..., International Journal of Cardiology, https://doi.org/10.1016/j.ijcard.2019.04.060