Noninvasive Evaluation With Multislice Computed Tomography in Suspected Acute Coronary SyndromePlaque Morphology on Multislice Computed Tomography Versus Coronary Calcium Score
Maureen M. Henneman, MD*,
Joanne D. Schuijf, PhD*, ,
Gabija Pundziute, MD*,
Jacob M. van Werkhoven, MSc*,
Ernst E. van der Wall, MD, PhD*,,
J. Wouter Jukema, MD, PhD*, and
Jeroen J. Bax, MD, PhD*,*
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
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Figure 1 Percentage of Segments With and Without Plaque, and Prevalence of the Different Plaque Types
(Left) Percentage of segments with plaque (solid area) and segments without plaque (open area). (Right) Prevalence of the different plaque types: noncalcified plaque (open area), mixed plaque (hatched area), and calcified plaque (solid area).
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Figure 2 Presence of Different Plaque Types in the Various Patient Groups
Patients with multivessel disease presented with relatively more mixed (55%) and less noncalcified plaques (30%) as compared with patients with nonobstructive coronary artery disease (CAD) and patients with single-vessel CAD. The prevalence of calcified plaques remained constant between the 3 groups (nonobstructive CAD: 12% vs. single-vessel CAD: 14% vs. multivessel CAD: 15%). Open bars = noncalcified plaques; hatched bars = mixed plaques; solid bars = calcified plaques.
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Figure 3 Presence of (Non)Obstructive CAD and the Presence of Plaque for the Different CS Groups
Note that a calcium score (CS) of 0 in only 15% of patients corresponded with complete absence of coronary artery disease (CAD), whereas 39% presented with obstructive CAD. Open bar = normal; hatched bars = plaque with nonobstructive CAD; solid bars = plaque with obstructive CAD.
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Figure 4 Example of a Patient Without Coronary Artery Calcium but With Obstructive CAD
This patient presented with suspected acute coronary syndrome. Multislice computed tomography showed no coronary artery calcium (A). However, obstructive noncalcified plaque and superimposed thrombus was observed in the distal segment of the right coronary artery on multislice computed tomography. (B) Volume-rendered reconstruction. (C) Multiplanar reconstruction, arrow indicating obstructive coronary artery disease (CAD) in right coronary artery (RCA). This finding was confirmed by conventional coronary angiography. (D) Conventional coronary angiography showing obstructive CAD in RCA (arrow). Ao = aorta; LAD = left anterior descending coronary artery; LCx = left circumflex coronary artery.
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