Multislice Computed Tomographic Characteristics of Coronary Lesions in Acute Coronary Syndromes
Sadako Motoyama, MD, PhD*,*,
Takeshi Kondo, MD, PhD ,
Masayoshi Sarai, MD, PhD*,
Atsushi Sugiura, MD, PhD*,
Hiroto Harigaya, MD*,
Takahisa Sato, MD, PhD*,
Kaori Inoue, MD*,
Masanori Okumura, MD*,
Junichi Ishii, MD, PhD*,
Hirofumi Anno, MD, PhD ,
Renu Virmani, MD, FACC ,
Yukio Ozaki, MD, PhD*,
Hitoshi Hishida, MD, PhD* and
Jagat Narula, MD, PhD, FACC¶
* Department of Cardiology, Fujita Health University, Toyoake, Japan
Department of Cardiology, Takase Clinic, Takasaki, Japan
Department of Radiology, Fujita Health University, Toyoake, Japan
International Registry of Pathology, Gaithersburg, Maryland
¶ Division of Cardiology, University of California Irvine, Irvine, California. Dr. James E. Muller acted as the Guest Editor for this article
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Figure 1 The Patient Population
Overall, 441 patients were screened and 71 were enrolled in the study. Of these 71 patients, 10 had STEMI, 9 had NSTEMI, 19 had UAP, and 33 had SAP. CAG = coronary artery grafting; MVD = multivessel disease; NSTEMI = non–ST-segment elevation myocardial infarction; PCI = percutaneous coronary intervention; SAP = stable angina pectoris; STEMI = ST-segment elevation myocardial infarction; SVD = single-vessel disease; UAP = unstable angina pectoris.
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Figure 2 Case 1 With Acute Coronary Syndrome
The CT characteristics of a culprit lesion in a 40-year-old male patient presenting with acute coronary syndrome. (A) Volume rendering. (B) Curved MPR. (C) Magnified view of the region of interest from (C). (D) Coronary angiogram. The white arrows in (A) and (D) show the site of luminal obstruction or culprit lesion. As shown by the solid yellow arrows at 2 sites in the culprit lesion in (C), the lesion is positively remodeled as compared with the normal coronary segment proximal to the lesion (denoted by interrupted arrows). Remodeling index in this patient was 1.43. An NCP <30 HU represents the probability of a soft plaque (red circles are placed along the course of low attenuation), and 30 HU <NCP <150 HU denotes a fibrous plaque (green squares). CT = computed tomography; LAD = left anterior descending artery; MPR = multiplanar reformation; NCP = noncalcified plaque.
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Figure 3 Case 2 With Acute Coronary Syndrome
The CT characteristics of another culprit lesion in a 79-year-old female patient presenting with acute coronary syndrome. (A) Volume rendering. (B) Curved MPR. (C) Coronary angiogram. The white arrows in (A) and (C) show the site of luminal obstruction or culprit lesion. In addition to positive remodeling and NCP plaque (also including areas of <30 HU), spotty calcification (pink arrows) is evident. Abbreviations as in Figure 2.
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Figure 4 Case 3 With Stable Angina Pectoris
The CT characteristics of a stable plaque from a 77-year-old male patient. The image shows negatively remodeled severely obstructive lesion almost entirely made up of 30 HU <NCP <150 HU (green squares). No NCP <30 HU or spotty calcification is observed. Remodeling index in this patient was 0.87. Abbreviations as in Figure 2.
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Figure 5 Plaque Characteristics in ACS and SAP
Plaque characteristics of culprit lesions in ACS and target lesions in SAP groups. Positive remodeling, NCP <30 HU, and spotty calcification were more frequently observed in the culprit ACS lesions. ACS = acute coronary syndrome; other abbreviations as in Figure 1.
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