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

Sadako Motoyama, Masayoshi Sarai, Hiroto Harigaya, Hirofumi Anno, Kaori Inoue, Tomonori Hara, Hiroyuki Naruse, Junichi Ishii, Hitoshi Hishida, Nathan D. Wong, Renu Virmani, Takeshi Kondo, Yukio Ozaki, Jagat Narula

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Abstract

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.

Original languageEnglish
Pages (from-to)49-57
Number of pages9
JournalJournal of the American College of Cardiology
Volume54
Issue number1
DOIs
Publication statusPublished - 30-06-2009

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Atherosclerotic Plaques
Acute Coronary Syndrome
Angiography
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Motoyama, Sadako ; Sarai, Masayoshi ; Harigaya, Hiroto ; Anno, Hirofumi ; Inoue, Kaori ; Hara, Tomonori ; Naruse, Hiroyuki ; Ishii, Junichi ; Hishida, Hitoshi ; Wong, Nathan D. ; Virmani, Renu ; Kondo, Takeshi ; Ozaki, Yukio ; Narula, Jagat. / Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome. In: Journal of the American College of Cardiology. 2009 ; Vol. 54, No. 1. pp. 49-57.
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title = "Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome",
abstract = "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.",
author = "Sadako Motoyama and Masayoshi Sarai and Hiroto Harigaya and Hirofumi Anno and Kaori Inoue and Tomonori Hara and Hiroyuki Naruse and Junichi Ishii and Hitoshi Hishida and Wong, {Nathan D.} and Renu Virmani and Takeshi Kondo and Yukio Ozaki and Jagat Narula",
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Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome. / Motoyama, Sadako; Sarai, Masayoshi; Harigaya, Hiroto; Anno, Hirofumi; Inoue, Kaori; Hara, Tomonori; Naruse, Hiroyuki; Ishii, Junichi; Hishida, Hitoshi; Wong, Nathan D.; Virmani, Renu; Kondo, Takeshi; Ozaki, Yukio; Narula, Jagat.

In: Journal of the American College of Cardiology, Vol. 54, No. 1, 30.06.2009, p. 49-57.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome

AU - Motoyama, 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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JF - Journal of the American College of Cardiology

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