TY - JOUR
T1 - Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome
AU - Tanizawa, Sadako
AU - Sarai, Masayoshi
AU - Harigaya, Hiroto
AU - Anno, Hirofumi
AU - Inoue, Kaori
AU - Hara, Tomonori
AU - Naruse, Hiroyuki
AU - Ishii, Junichi
AU - Hishida, Hitoshi
AU - Wong, Nathan D.
AU - Virmani, Renu
AU - Kondo, Takeshi
AU - Ozaki, Yukio
AU - Narula, Jagat
PY - 2009/6/30
Y1 - 2009/6/30
N2 - 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.
AB - 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.
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U2 - 10.1016/j.jacc.2009.02.068
DO - 10.1016/j.jacc.2009.02.068
M3 - Article
C2 - 19555840
AN - SCOPUS:67449094568
SN - 0735-1097
VL - 54
SP - 49
EP - 57
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -