Clinical Investigation
Imaging and Diagnostic Testing
Volumetric evaluation of coronary plaque in patients presenting with acute myocardial infarction or stable angina pectoris—a multislice computerized tomography study

https://doi.org/10.1016/j.ahj.2008.10.011Get rights and content

Background

We hypothesized that unstable clinical presentation of coronary artery disease is associated with distinct characteristics of culprit lesions identifiable by multislice computed tomography (MSCT).

Methods

Patients with non–ST-elevation myocardial infarction (NSTEMI) (n = 57) or stable angina (SA) pectoris (n = 19) were studied. Coronary culprit lesions in patients with NSTEMI and symptomatic lesions in patients with SA were evaluated with 64-slice MSCT and a volumetric plaque imaging tool. Plaque volumes of lipid, fibrous tissue, or calcification according to signal intensity were determined. Plaque burden, mean signal intensity of the lesions, relative volumetric distribution of plaque components, and remodeling index were measured.

Results

Volumetric plaque burden of study lesions were similar in the 2 patient groups (P = .38). Mean signal intensity of study lesions were lower in patients with NSTEMI compared with patients with SA (74 [66-97] Hounsfield units vs 99 [77-154] Hounsfield units, P = .02). The volume of plaque occupied by calcified material was lower in patients with NSTEMI compared with patients with SA (15 mm3 [3-58 mm3] vs 42 mm3 [18-82 mm3], P = .045). In patients with NSTEMI, the lipid-rich plaque subtype was more frequent than in patients with SA, and the calcified plaque subtype was less frequent in patients with NSTEMI than in patients with SA (P = .032). Positive remodeling was observed in 19% of patients with NSTEMI, whereas this was absent in patients with SA (P = .04).

Conclusion

Volumetric measurements with MSCT revealed that coronary culprit lesions in acute coronary syndrome frequently display low mean plaque signal intensity values, lipid-rich plaque subtype, and positive remodeling.

Section snippets

Methods

Patients undergoing invasive coronary angiography at Rigshospitalet, Copenhagen, Denmark, presenting clinically with either NSTEMI or SA as defined in the European Society of Cardiology guidelines were randomly selected for inclusion in the study.14 Selection of patients for the study reflected the casemix of referred patients and was performed in a 3:1 ratio (NSTEMI/SA), matched by the number of significant coronary lesions (>50% diameter stenosis) identified by invasive coronary angiography

Results

A total of 76 patients were included in the study: 57 patients with a recent NSTEMI and 19 with SA. Patient characteristics are summarized in Table I. The 2 patient groups were well matched, except that more patients with SA had hypertension. More than one significant coronary lesion was noted in 11 patients with SA and 30 patients with NSTEMI. In 7 patients with SA, the coronary study lesion was identified based on stress testing and in 4 as the most severely stenosed lesion. In the 30

Discussion

Our results demonstrate that MSCT allows noninvasive quantification of differences in coronary plaque characteristics between patients with unstable and stable coronary artery disease, although a considerable overlap between groups was noted. We found a significant difference in mean plaque signal intensity value and plaque subtypes of culprit lesions between the 2 patient groups despite similar global Agatston calcium scores. Furthermore, culprit lesions in patients with NSTEMI showed positive

Conclusion

Volumetric quantification of coronary artery atherosclerotic plaque composition can be achieved by MSCT. There was a significant difference in the distribution of plaque subtypes in patients with NSTEMI and SA. Further studies are warranted to determine whether MSCT plaque evaluation can provide prognostic information in the search of the vulnerable patient.

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