Dey Damini, Achenbach Stephan, Schuhbaeck Annika, Pflederer Tobias, Nakazato Ryo, Slomka Piotr J, Berman Daniel S, Marwan Mohamed
Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Taper Building, Room A238, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.
Department of Internal Medicine 2, University of Erlangen, Erlangen, Germany.
J Cardiovasc Comput Tomogr. 2014 Sep-Oct;8(5):368-74. doi: 10.1016/j.jcct.2014.07.007. Epub 2014 Aug 23.
Coronary CTA allows characterization of non-calcified and calcified plaque and identification of high-risk plaque features.
We aimed to quantitatively characterize and compare coronary plaque burden from CTA in patients with a first acute coronary syndrome (ACS) and controls with stable coronary artery disease.
We retrospectively analyzed consecutive patients with non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina with a first ACS, who underwent CTA as part of their initial workup before invasive coronary angiography and age- and gender-matched controls with stable chest pain; controls also underwent CTA with subsequent invasive angiography (total n = 28). Culprit arteries were identified in ACS patients. Coronary arteries were analyzed by automated software to quantify calcified plaque (CP), noncalcified plaque (NCP), and low-density NCP (LD-NCP, attenuation <30 Hounsfield units) volumes, and corresponding burden (plaque volume × 100%/vessel volume), stenosis, remodeling index, contrast density difference (maximum percent difference in attenuation/cross-sectional area from proximal cross-section), and plaque length.
ACS patients had fewer lesions (median, 1), with higher total NCP and LD-NCP burdens (NCP: 57.4% vs 41.5%; LD-NCP: 12.5% vs 8%; P ≤ .04), higher maximal stenoses (85.6% vs 53.0%; P = .003) and contrast density differences (46.1 vs 16.3%; P < .006). Per-patient CP burden was not different between ACS and controls. NCP and LD-NCP plaque burden was higher in culprit vs nonculprit arteries (NCP: 57.8% vs 9.5%; LD-NCP: 8.4% vs 0.6%; P ≤ .0003); CP was not significantly different. Culprit arteries had increased plaque lengths, remodeling indices, stenoses, and contrast density differences (46.1% vs 10.9%; P ≤ .001).
Noninvasive quantitative coronary artery analysis identified several differences for ACS, both on per-patient and per-vessel basis, including increased NCP, LD-NCP burden, and contrast density difference.
冠状动脉CT血管造影（CTA）能够对非钙化和钙化斑块进行特征描述，并识别高危斑块特征。
我们旨在对首次发生急性冠状动脉综合征（ACS）的患者和稳定型冠状动脉疾病对照组的CTA冠状动脉斑块负荷进行定量特征描述和比较。
我们回顾性分析了连续的非ST段抬高型心肌梗死（NSTEMI）或首次发生ACS的不稳定型心绞痛患者，这些患者在进行有创冠状动脉造影之前接受了CTA作为初始检查的一部分，以及年龄和性别匹配的有稳定胸痛症状的对照组；对照组也接受了CTA检查及随后的有创血管造影（共28例）。在ACS患者中确定罪犯血管。通过自动化软件分析冠状动脉，以量化钙化斑块（CP）、非钙化斑块（NCP）和低密度NCP（LD-NCP，衰减值<30亨氏单位）的体积，以及相应的负荷（斑块体积×100%/血管体积）、狭窄程度、重塑指数、对比剂密度差异（近端横截面衰减/横截面积的最大百分比差异）和斑块长度。
ACS患者的病变较少（中位数为1个），总NCP和LD-NCP负荷较高（NCP：57.4%对41.5%；LD-NCP：12.5%对8%；P≤0.04），最大狭窄程度较高（85.6%对53.0%；P=0.003），对比剂密度差异较大（46.1对16.3%；P<0.006）。ACS患者和对照组之间的每例患者CP负荷无差异。罪犯血管与非罪犯血管相比，NCP和LD-NCP斑块负荷更高（NCP：57.8%对9.5%；LD-NCP：8.4%对0.6%；P≤0.0003）；CP无显著差异。罪犯血管的斑块长度、重塑指数、狭窄程度和对比剂密度差异增加（46.1%对10.9%；P≤0.001）。
无创性冠状动脉定量分析在每例患者和每支血管基础上均发现了ACS的一些差异，包括NCP、LD-NCP负荷增加以及对比剂密度差异增加。
