Characterization of Noncalcified Coronary Plaques and Identification of Culprit Lesions in Patients With Acute Coronary Syndrome by 64-Slice Computed Tomography
Toshiro Kitagawa, MD*,
Hideya Yamamoto, MD, FACC*,*,
Jun Horiguchi, MD ,
Norihiko Ohhashi, MD*,
Futoshi Tadehara, MD*,
Tomoki Shokawa, MD*,
Yoshihiro Dohi, MD*,
Eiji Kunita, MD*,
Hiroto Utsunomiya, MD*,
Nobuoki Kohno, MD ,
Yasuki Kihara, MD, FACC*
* Department of Cardiovascular Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan
* Reprint requests and correspondence: Dr. Hideya Yamamoto, Department of Cardiovascular Medicine, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima 734-8551, Japan (Email: hideyayama{at}hiroshima-u.ac.jp).
Objectives: 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).
Background: Lower CT density, positive remodeling, and adjacent spotty coronary calcium are characteristic vessel changes in unstable coronary plaques.
Methods: 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.
Results: 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.
Conclusions: Sixty-four-slice CT angiography demonstrates a higher prevalence of NCPs with vulnerable characteristics in patients with ACS as compared with stable clinical presentation.
Key Words: acute coronary syndrome • multidetector computed tomography • noncalcified coronary plaque
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Abbreviations and Acronyms
| | ACS = acute coronary syndrome | | CT = computed tomography | | ECG = electrocardiogram | | HU = Hounsfield units | | IVUS = intravascular ultrasound | | MDCT = multidetector computed tomography | | NCP = noncalcified coronary atherosclerotic plaque | | NSTEMI = non–ST-segment elevation myocardial infarction | | PR = positive remodeling | | RI = remodeling index |
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