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J Am Coll Cardiol, 2009; 54:49-57, doi:10.1016/j.jacc.2009.02.068
© 2009 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CARDIAC IMAGING

Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome

Sadako Motoyama, MD, PhD*,{ddagger},*, Masayoshi Sarai, MD, PhD*, Hiroto Harigaya, MD*, Hirofumi Anno, MD, PhD{dagger}, Kaori Inoue, MD*, Tomonori Hara, MD*, Hiroyuki Naruse, MD, PhD*, Junichi Ishii, MD, PhD*, Hitoshi Hishida, MD, PhD*, Nathan D. Wong, PhD{ddagger}, Renu Virmani, MD§, Takeshi Kondo, MD, PhD||, Yukio Ozaki, MD, PhD* and Jagat Narula, MD, PhD{ddagger}

* Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
{dagger} Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
{ddagger} Division of Cardiology, University of California Irvine School of Medicine, Irvine, California
§ Cardiovascular Pathology Institute, Gaithersburg, Maryland
|| Department of Cardiology, Takese Clinic, Takasaki, Japan

Manuscript received August 14, 2008; revised manuscript received February 10, 2009, accepted February 10, 2009.

* Reprint requests and correspondence: Dr. Sadako Motoyama, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan (Email: sadakom{at}fujita-hu.ac.jp).

Objectives: In a computed tomographic (CT) angiography study, we identified the characteristics of atherosclerotic lesions that were associated with subsequent development of acute coronary syndrome (ACS).

Background: The CT characteristics of culprit lesions in ACS include positive vessel remodeling (PR) and low-attenuation plaques (LAP). These 2 features have been observed in the lesions that have already resulted in ACS, but their prospective relation to ACS has not been previously described.

Methods: In 1,059 patients who underwent CT angiography, atherosclerotic lesions were analyzed for the presence of 2 features: PR and LAP. The remodeling index, and plaque and LAP areas and volumes were calculated. The plaque characteristics of lesions resulting in ACS during the follow-up of 27 ± 10 months were evaluated.

Results: Of the 45 patients showing plaques with both PR and LAP (2-feature positive plaques), ACS developed in 10 (22.2%), compared with 1 (3.7%) of the 27 patients with plaques displaying either feature (1-feature positive plaques). In only 4 (0.5%) of the 820 patients with neither PR nor LAP (2-feature negative plaques) did ACS develop. None of the 167 patients with normal angiograms had acute coronary events (p < 0.001). ACS was independently predicted by PR and/or LAP (hazard ratio: 22.8, 95% confidence interval: 6.9 to 75.2, p < 0.001). Among 2- or 1-feature positive segments, those resulting in ACS demonstrated significantly larger remodeling index (126.7 ± 3.9% vs. 113.4 ± 1.6%, p = 0.003), plaque volume (134.9 ± 14.1 mm3 vs. 57.8 ± 5.7 mm3, p < 0.001), LAP volume (20.4 ± 3.4 mm3 vs. 1.1 ± 1.4 mm3, p < 0.001), and percent LAP/total plaque area (21.4 ± 3.7 mm2 vs. 7.7 ± 1.5 mm2, p = 0.001) compared with segments not resulting in ACS.

Conclusions: The patients demonstrating positively remodeled coronary segments with low-attenuation plaques on CT angiography were at a higher risk of ACS developing over time when compared with patients having lesions without these characteristics.

Key Words: coronary artery disease • atherosclerosis • acute coronary syndrome • computed tomography • vessel remodeling • primary prevention

Abbreviations and Acronyms
  ACS = acute coronary syndrome
  CT = computed tomography
  IVUS = intravascular ultrasound
  LAP = low attenuation plaque(s)
  NCP = noncalcified plaque(s)
  PR = positive vessel remodeling


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 J Am Coll CardiolHome page
E. Braunwald
Noninvasive Detection of Vulnerable Coronary Plaques: Locking the Barn Door Before the Horse Is Stolen
J. Am. Coll. Cardiol., June 30, 2009; 54(1): 58 - 59.
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