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Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome.
Circ Cardiovasc Imaging. 2018 08; 11(8):e007657.CC

Abstract

Background High-risk plaque (HRP) features as detected by coronary computed tomography angiography (CTA) predict acute coronary syndrome (ACS). We sought to determine whether coronary CTA-specific definitions of HRP improve discrimination of patients with ACS as compared with definitions from intravascular ultrasound (IVUS). Methods and Results In patients with suspected ACS, randomized to coronary CTA in the ROMICAT II (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography II) trial, we retrospectively performed semiautomated quantitative analysis of HRP (including remodeling index, plaque burden as derived by plaque area, low computed tomography attenuation plaque volume) and degree of luminal stenosis and analyzed the performance of traditional IVUS thresholds to detect ACS. Furthermore, we derived CTA-specific thresholds in patients with ACS to detect culprit lesions and applied those to all patients to calculate the discriminatory ability to detect ACS in comparison to IVUS thresholds. Of 472 patients, 255 patients (56±7.8 years; 63% men) had coronary plaque. In 32 patients (6.8%) with ACS, culprit plaques (n=35) differed from nonculprit plaques (n=172) with significantly greater values for all HRP features except minimal luminal area (significantly lower; all P<0.01). IVUS definitions showed good performance while minimal luminal area (odds ratio: 6.82; P=0.014) and plaque burden (odds ratio: 5.71; P=0.008) were independently associated with ACS but not remodeling index (odds ratio: 0.78; P=0.673). Optimized CTA-specific thresholds for plaque burden (area under the curve: 0.832 versus 0.676) and degree of stenosis (area under the curve: 0.826 versus 0.721) showed significantly higher diagnostic performance for ACS as compared with IVUS-based thresholds (all P<0.05) with borderline significance for minimal luminal area (area under the curve: 0.817 versus 0.742; P=0.066). Conclusions CTA-specific definitions of HRP features may improve the discrimination of patients with ACS as compared with IVUS-based definitions. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01084239.

Authors+Show Affiliations

Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.). Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.). Massachusetts General Hospital and Harvard Medical School, Boston. Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Germany (D.O.B.).Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.). Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.). School of Business Studies, Stralsund University of Applied Sciences, Germany (T.M.).Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.). Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.). Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Austria (S.B.P.).Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.). Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary (P.M.-H.).Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.). Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).Division of Image Processing, Department of Radiology, Leiden University Medical Center, the Netherlands (P.H.K., A.B.). Medis Medical Imaging Systems B.V, Leiden, the Netherlands (P.H.K.).Division of Image Processing, Department of Radiology, Leiden University Medical Center, the Netherlands (P.H.K., A.B.).No affiliation info availableDalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (Q.A.T.).No affiliation info availableDepartment of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.). Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.).Department of Radiology (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.). Cardiac MR PET CT Program (D.O.B., T.M., S.B.P., M.T.L., K.G., U.H., M.F.). Department of Radiology, University of Tuebingen, Germany (F.B.).

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30354493

Citation

Bittner, Daniel O., et al. "Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome." Circulation. Cardiovascular Imaging, vol. 11, no. 8, 2018, pp. e007657.
Bittner DO, Mayrhofer T, Puchner SB, et al. Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome. Circ Cardiovasc Imaging. 2018;11(8):e007657.
Bittner, D. O., Mayrhofer, T., Puchner, S. B., Lu, M. T., Maurovich-Horvat, P., Ghemigian, K., Kitslaar, P. H., Broersen, A., Bamberg, F., Truong, Q. A., Schlett, C. L., Hoffmann, U., & Ferencik, M. (2018). Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome. Circulation. Cardiovascular Imaging, 11(8), e007657. https://doi.org/10.1161/CIRCIMAGING.118.007657
Bittner DO, et al. Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome. Circ Cardiovasc Imaging. 2018;11(8):e007657. PubMed PMID: 30354493.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome. AU - Bittner,Daniel O, AU - Mayrhofer,Thomas, AU - Puchner,Stefan B, AU - Lu,Michael T, AU - Maurovich-Horvat,Pal, AU - Ghemigian,Khristine, AU - Kitslaar,Pieter H, AU - Broersen,Alexander, AU - Bamberg,Fabian, AU - Truong,Quynh A, AU - Schlett,Christopher L, AU - Hoffmann,Udo, AU - Ferencik,Maros, PY - 2018/10/26/entrez PY - 2018/10/26/pubmed PY - 2019/8/14/medline KW - acute coronary syndrome KW - angiography KW - computed tomography angiography KW - coronary angiography KW - myocardial ischemia KW - tomography, X-ray computed KW - ultrasonography, intravascular SP - e007657 EP - e007657 JF - Circulation. Cardiovascular imaging JO - Circ Cardiovasc Imaging VL - 11 IS - 8 N2 - Background High-risk plaque (HRP) features as detected by coronary computed tomography angiography (CTA) predict acute coronary syndrome (ACS). We sought to determine whether coronary CTA-specific definitions of HRP improve discrimination of patients with ACS as compared with definitions from intravascular ultrasound (IVUS). Methods and Results In patients with suspected ACS, randomized to coronary CTA in the ROMICAT II (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography II) trial, we retrospectively performed semiautomated quantitative analysis of HRP (including remodeling index, plaque burden as derived by plaque area, low computed tomography attenuation plaque volume) and degree of luminal stenosis and analyzed the performance of traditional IVUS thresholds to detect ACS. Furthermore, we derived CTA-specific thresholds in patients with ACS to detect culprit lesions and applied those to all patients to calculate the discriminatory ability to detect ACS in comparison to IVUS thresholds. Of 472 patients, 255 patients (56±7.8 years; 63% men) had coronary plaque. In 32 patients (6.8%) with ACS, culprit plaques (n=35) differed from nonculprit plaques (n=172) with significantly greater values for all HRP features except minimal luminal area (significantly lower; all P<0.01). IVUS definitions showed good performance while minimal luminal area (odds ratio: 6.82; P=0.014) and plaque burden (odds ratio: 5.71; P=0.008) were independently associated with ACS but not remodeling index (odds ratio: 0.78; P=0.673). Optimized CTA-specific thresholds for plaque burden (area under the curve: 0.832 versus 0.676) and degree of stenosis (area under the curve: 0.826 versus 0.721) showed significantly higher diagnostic performance for ACS as compared with IVUS-based thresholds (all P<0.05) with borderline significance for minimal luminal area (area under the curve: 0.817 versus 0.742; P=0.066). Conclusions CTA-specific definitions of HRP features may improve the discrimination of patients with ACS as compared with IVUS-based definitions. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01084239. SN - 1942-0080 UR - https://www.unboundmedicine.com/medline/citation/30354493/Coronary_Computed_Tomography_Angiography_Specific_Definitions_of_High_Risk_Plaque_Features_Improve_Detection_of_Acute_Coronary_Syndrome_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.118.007657?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -