To explore the imaging features of patients with non-ST elevation acute coronary syndrome (ACS) using optical coherence tomography(OCT).

The clinical data of one patient with ACS were analyzed.The coronary culprit vascular lesions were detected by coronary angiography, intravenous ultrasound(IVUS) and OCT, respectively.

The patient presented with repeately progressive chest pain at rest.Physical examination and chest X-ray results were normal.Electrocardiogram (ECG) showed a q/Q wave in Ⅱ, Ⅲ, and avF leads and inverted T wave in V₅~V₆, cardiac troponin I level was 0.20 mg/L (the normal value was <0.04 mg/L). Transthoracic echocardiography manifested left ventricular ejection fraction as 50% with weak inferior wall motion.The coronary angiogram presented that stents in left anterior descending(LAD) were normal.The left circumflex artery showed total occlusion similar to the last procedure, which was performed 8 months ago.A large right coronary artery with a slight stenotic lesion in the proximal artery was found.IVUS images demonstrated that the right coronary stenotic lesion had a false lumen, the plaque burden was 73% and the minimum lumen area was 5.80 mm².OCT results exhibited that the plaque contained a thin fibrous cap (0.70 μm), which was rich in lipid, accompained by plaque rupture and intimal tear.

The coronary culprit vascular lesions of ACS can be detected by using OCT technique.