Optical Coherence Tomography in Acute Coronary Syndromes

Angiography remains the standard imaging modality during cardiac catheterization; however, this technique provides only a two-dimensional representation of the coronary lumen, which limits the assessment of vessel wall pathology. In comparison, intravascular imaging techniques, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), provide high-resolution cross-sectional and two-dimensional reconstructions of the coronary arteries. Thus, these modalities complement angiographic findings, enable detailed evaluation of underlying pathology, and facilitate precise procedural guidance. Advancements in imaging technologies, including near-infrared spectroscopy and virtual histology intravascular ultrasound, further enhance lesion characterization and procedural planning. An increasing body of evidence from registries, randomized controlled trials, and meta-analyses supports the use of intravascular imaging-guided percutaneous coronary interventions, demonstrating improved procedural success rates and superior long-term clinical outcomes. In the context of acute coronary syndromes (ACS), OCT offers critical diagnostic insights that enhance accuracy and inform optimal treatment strategies. This review highlights the evolving role of OCT in the management of ACS and the favorable impact of this technique on patient outcomes.