Characterization of Noncalcified Coronary Plaques and Identification of Culprit Lesions in Patients With Acute Coronary Syndrome by 64-Slice Computed Tomography

• Published in: JACC. Cardiovascular imaging Vol. 2; no. 2; pp. 153 - 160
• Main Authors: Kitagawa, Toshiro, Yamamoto, Hideya, Horiguchi, Jun, Ohhashi, Norihiko, Tadehara, Futoshi, Shokawa, Tomoki, Dohi, Yoshihiro, Kunita, Eiji, Utsunomiya, Hiroto, Kohno, Nobuoki, Kihara, Yasuki
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2009
• Subjects: acute coronary syndrome; Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - etiology; Aged; Cardiovascular; Coronary Angiography - methods; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Female; Humans; Male; Middle Aged; multidetector computed tomography; noncalcified coronary plaque; Predictive Value of Tests; Radiographic Image Interpretation, Computer-Assisted; Retrospective Studies; Severity of Illness Index; Tomography, X-Ray Computed; NSTEMI; PR; ECG; noncalcified coronary plaque; IVUS; MDCT; HU; ACS; CT; acute coronary syndrome; multidetector computed tomography; RI; NCP; computed tomography; non–ST-segment elevation myocardial infarction; positive remodeling; intravascular ultrasound; electrocardiogram; remodeling index; Hounsfield units; noncalcified coronary atherosclerotic plaque
• ISSN: 1936-878X; 1876-7591; 1876-7591
• DOI: 10.1016/j.jcmg.2008.09.015

Characterization of Noncalcified Coronary Plaques and Identification of Culprit Lesions in Patients With Acute Coronary Syndrome by 64-Slice Computed Tomography Toshiro Kitagawa, Hideya Yamamoto, Jun Horiguchi, Norihiko Ohhashi, Futoshi Tadehara, Tomoki Shokawa, Yoshihiro Dohi, Eiji Kunita, Hiroto Utsunomiya, Nobuoki Kohno, Yasuki Kihara Lower computed tomography (CT) density, positive remodeling, and adjacent spotty coronary calcium are characteristic vessel changes in unstable coronary plaques. The authors studied noncalcified coronary atherosclerotic plaques (NCPs) in patients presenting with acute coronary syndromes (ACS) and compared them to stable patients. More NCPs were observed in ACS patients, in whom minimum CT density was lower and frequency of adjacent spotty calcium was higher. In the ACS group, remodeling index was significantly greater and a larger index was independently related to the culprit lesions. The findings support a potential role of CT imaging in recognition of rupture-prone coronary plaques. We sought to characterize noncalcified coronary atherosclerotic plaques in culprit and remote coronary atherosclerotic lesions in patients with acute coronary syndrome (ACS) with 64-slice computed tomography (CT). Lower CT density, positive remodeling, and adjacent spotty coronary calcium are characteristic vessel changes in unstable coronary plaques. Of 147 consecutive patients who underwent contrast-enhanced 64-slice CT examination for coronary artery visualization, 101 (ACS; n = 21, non-ACS; n = 80) having 228 noncalcified coronary atherosclerotic plaques (NCPs) were studied. Each NCP detected within the vessel wall was evaluated by determining minimum CT density, vascular remodeling index (RI), and morphology of adjacent calcium deposits. The CT visualized more NCPs in ACS patients (65 lesions, 3.1 ± 1.2/patient) than in non-ACS patients (163 lesions, 2.0 ± 1.1/patient). Minimum CT density (24 ± 22 vs. 42 ± 29 Hounsfield units [HU], p < 0.01), RI (1.14 ± 0.18 vs. 1.08 ± 0.19, p = 0.02), and frequency of adjacent spotty calcium of NCPs (60% vs. 38%, p < 0.01) were significantly different between ACS and non-ACS patients. Frequency of NCPs with minimum CT density <40 HU, RI >1.05, and adjacent spotty calcium was approximately 2-fold higher in the ACS group than in the non-ACS group (43% vs. 22%, p < 0.01). In the ACS group, only RI was significantly different between 21 culprit and 44 nonculprit lesions (1.26 ± 0.16 vs. 1.09 ± 0.17, p < 0.01), and a larger RI (≥1.23) was independently related to the culprit lesions (odds ratio: 12.3; 95% confidential interval: 2.9 to 68.7, p < 0.01), but there was a substantial overlap of the distribution of RI values in these 2 groups of lesions. Sixty-four-slice CT angiography demonstrates a higher prevalence of NCPs with vulnerable characteristics in patients with ACS as compared with stable clinical presentation.