In vivo quantitative assessment of atherosclerotic plaque: A validation study on the optical coherence tomography-derived index of plaque attenuation

Growing evidence indicates that coronary plaque instability is an independent risk factor for adverse coronary events, yet current optical coherence tomography (OCT) assessment of high-risk plaque characteristics (HRPC) relies largely on qualitative interpretation. The index of plaque attenuation (IPA) is a quantitative OCT-based metric that may provide a more objective evaluation. This retrospective observational diagnostic accuracy study assessed the performance of OCT-derived IPA for HRPC detection in patients with acute coronary syndrome or stable angina, using expert consensus qualitative OCT analysis as the reference standard. A total of 560 analyzable OCT cross‐sections from 83 patients were categorized as HRPC or non-HRPC, with the latter grouped into progression plaque characteristics (PPC) or normal vessels. Receiver operating characteristic analysis was performed. IPA 11 distinguished HRPC from non-HRPC with an area under the curve of 0.75 (95% confidence interval: 70.3–79.0; P < .001), sensitivity of 76.1%, and specificity of 63.8%. IPA 11 was higher in HRPC than in non-HRPC (66.0 [38.0–110.0] vs 20.0 [2.0–52.0]; P = .001). In the non-HRPC group, IPA 8 differentiated PPC from normal vessels with an area under the curve of 0.98 (95% CI: 95.3–98.8; P < .001), with higher values in PPC (241.0 [155.5–320.5] vs 11.0 [3.5–30.5]; P < .001). IPA offers an objective, quantitative method for automated OCT-based plaque assessment, demonstrating good accuracy for HRPC identification and excellent discrimination of PPC from normal vessels, meriting validation in larger prospective studies.