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Comparison of quantitative atherosclerotic plaque burden from coronary CT angiography in patients with first acute coronary syndrome and stable coronary artery disease.
J Cardiovasc Comput Tomogr. 2014 Sep-Oct; 8(5):368-74.JC

Abstract

BACKGROUND

Coronary CTA allows characterization of non-calcified and calcified plaque and identification of high-risk plaque features.

OBJECTIVE

We aimed to quantitatively characterize and compare coronary plaque burden from CTA in patients with a first acute coronary syndrome (ACS) and controls with stable coronary artery disease.

MATERIALS AND METHODS

We retrospectively analyzed consecutive patients with non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina with a first ACS, who underwent CTA as part of their initial workup before invasive coronary angiography and age- and gender-matched controls with stable chest pain; controls also underwent CTA with subsequent invasive angiography (total n = 28). Culprit arteries were identified in ACS patients. Coronary arteries were analyzed by automated software to quantify calcified plaque (CP), noncalcified plaque (NCP), and low-density NCP (LD-NCP, attenuation <30 Hounsfield units) volumes, and corresponding burden (plaque volume × 100%/vessel volume), stenosis, remodeling index, contrast density difference (maximum percent difference in attenuation/cross-sectional area from proximal cross-section), and plaque length.

RESULTS

ACS patients had fewer lesions (median, 1), with higher total NCP and LD-NCP burdens (NCP: 57.4% vs 41.5%; LD-NCP: 12.5% vs 8%; P ≤ .04), higher maximal stenoses (85.6% vs 53.0%; P = .003) and contrast density differences (46.1 vs 16.3%; P < .006). Per-patient CP burden was not different between ACS and controls. NCP and LD-NCP plaque burden was higher in culprit vs nonculprit arteries (NCP: 57.8% vs 9.5%; LD-NCP: 8.4% vs 0.6%; P ≤ .0003); CP was not significantly different. Culprit arteries had increased plaque lengths, remodeling indices, stenoses, and contrast density differences (46.1% vs 10.9%; P ≤ .001).

CONCLUSION

Noninvasive quantitative coronary artery analysis identified several differences for ACS, both on per-patient and per-vessel basis, including increased NCP, LD-NCP burden, and contrast density difference.

Authors+Show Affiliations

Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Taper Building, Room A238, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA. Electronic address: Damini.Dey@cshs.org.Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany.Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany.Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany.Department of Imaging and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.Department of Imaging and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25301042

Citation

Dey, Damini, et al. "Comparison of Quantitative Atherosclerotic Plaque Burden From Coronary CT Angiography in Patients With First Acute Coronary Syndrome and Stable Coronary Artery Disease." Journal of Cardiovascular Computed Tomography, vol. 8, no. 5, 2014, pp. 368-74.
Dey D, Achenbach S, Schuhbaeck A, et al. Comparison of quantitative atherosclerotic plaque burden from coronary CT angiography in patients with first acute coronary syndrome and stable coronary artery disease. J Cardiovasc Comput Tomogr. 2014;8(5):368-74.
Dey, D., Achenbach, S., Schuhbaeck, A., Pflederer, T., Nakazato, R., Slomka, P. J., Berman, D. S., & Marwan, M. (2014). Comparison of quantitative atherosclerotic plaque burden from coronary CT angiography in patients with first acute coronary syndrome and stable coronary artery disease. Journal of Cardiovascular Computed Tomography, 8(5), 368-74. https://doi.org/10.1016/j.jcct.2014.07.007
Dey D, et al. Comparison of Quantitative Atherosclerotic Plaque Burden From Coronary CT Angiography in Patients With First Acute Coronary Syndrome and Stable Coronary Artery Disease. J Cardiovasc Comput Tomogr. 2014 Sep-Oct;8(5):368-74. PubMed PMID: 25301042.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of quantitative atherosclerotic plaque burden from coronary CT angiography in patients with first acute coronary syndrome and stable coronary artery disease. AU - Dey,Damini, AU - Achenbach,Stephan, AU - Schuhbaeck,Annika, AU - Pflederer,Tobias, AU - Nakazato,Ryo, AU - Slomka,Piotr J, AU - Berman,Daniel S, AU - Marwan,Mohamed, Y1 - 2014/08/23/ PY - 2013/08/16/received PY - 2014/02/15/revised PY - 2014/07/15/accepted PY - 2014/10/11/entrez PY - 2014/10/11/pubmed PY - 2015/6/16/medline KW - Acute coronary syndrome KW - Coronary CT angiography KW - Coronary plaque KW - Plaque burden KW - Plaque quantification KW - Plaque volume KW - Quantitative coronary tree analysis SP - 368 EP - 74 JF - Journal of cardiovascular computed tomography JO - J Cardiovasc Comput Tomogr VL - 8 IS - 5 N2 - BACKGROUND: Coronary CTA allows characterization of non-calcified and calcified plaque and identification of high-risk plaque features. OBJECTIVE: We aimed to quantitatively characterize and compare coronary plaque burden from CTA in patients with a first acute coronary syndrome (ACS) and controls with stable coronary artery disease. MATERIALS AND METHODS: We retrospectively analyzed consecutive patients with non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina with a first ACS, who underwent CTA as part of their initial workup before invasive coronary angiography and age- and gender-matched controls with stable chest pain; controls also underwent CTA with subsequent invasive angiography (total n = 28). Culprit arteries were identified in ACS patients. Coronary arteries were analyzed by automated software to quantify calcified plaque (CP), noncalcified plaque (NCP), and low-density NCP (LD-NCP, attenuation <30 Hounsfield units) volumes, and corresponding burden (plaque volume × 100%/vessel volume), stenosis, remodeling index, contrast density difference (maximum percent difference in attenuation/cross-sectional area from proximal cross-section), and plaque length. RESULTS: ACS patients had fewer lesions (median, 1), with higher total NCP and LD-NCP burdens (NCP: 57.4% vs 41.5%; LD-NCP: 12.5% vs 8%; P ≤ .04), higher maximal stenoses (85.6% vs 53.0%; P = .003) and contrast density differences (46.1 vs 16.3%; P < .006). Per-patient CP burden was not different between ACS and controls. NCP and LD-NCP plaque burden was higher in culprit vs nonculprit arteries (NCP: 57.8% vs 9.5%; LD-NCP: 8.4% vs 0.6%; P ≤ .0003); CP was not significantly different. Culprit arteries had increased plaque lengths, remodeling indices, stenoses, and contrast density differences (46.1% vs 10.9%; P ≤ .001). CONCLUSION: Noninvasive quantitative coronary artery analysis identified several differences for ACS, both on per-patient and per-vessel basis, including increased NCP, LD-NCP burden, and contrast density difference. SN - 1876-861X UR - https://www.unboundmedicine.com/medline/citation/25301042/Comparison_of_quantitative_atherosclerotic_plaque_burden_from_coronary_CT_angiography_in_patients_with_first_acute_coronary_syndrome_and_stable_coronary_artery_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1934-5925(14)00213-5 DB - PRIME DP - Unbound Medicine ER -