Coronary CT angiographic characteristics of culprit lesions in acute coronary syndromes not related to plaque rupture as defined by optical coherence tomography and angioscopy
Open Access
- 30 June 2011
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 32 (22), 2814-2823
- https://doi.org/10.1093/eurheartj/ehr189
Abstract
Pathological and clinical optical coherence tomography (OCT) studies have indicated that acute coronary syndrome (ACS) lesions have either ruptured fibrous caps (RFC-ACS) or intact fibrous caps (IFC-ACS). Although computed tomographic (CT) angiographic characteristics of RFC-ACS include low-attenuation plaques and positive plaque remodelling, features associated with IFC-ACS have not been previously described. The aim of this study was to assess the CT characteristics of IFC-ACS lesions. Seventy-four patients with ACS/stable angina consented to multimodality imaging, of which 66 underwent CT angiography. Of these, 57 culprit lesions in 57 patients were evaluated with sufficient image quality from all four of OCT, angioscopy, intravascular ultrasound, and CT angiography. Intraluminal thrombus was assessed by OCT/angioscopy, and culprit lesions further classified by OCT-based demonstration of fibrous cap integrity. Of 35 culprit lesions with ACS, OCT revealed IFC with thrombus in 10 (29%) and RFC in the remaining 25 (71%); all 22 lesions with stable angina had intact fibrous caps. Fibrous caps were significantly thinner in RFC-ACS than IFC-ACS and stable angina (45 ± 12, 131 ± 57, and 321 ± 146 μm, respectively; P = 0.001). CT angiography revealed that low-attenuation plaques were more frequently observed in RFC-ACS than IFC-ACS and stable angina (88, 40, and 18%; P = 0.001) lesions. Similarly, positive remodelling was more predominantly seen in RFC-ACS than IFC-ACS and stable angina (96, 20, and 14%; P = 0.001). However, none of the specific CT angiography features clearly distinguished IFC-ACS from stable lesions. In contrast to the situation with RFC-ACS, distinct culprit lesion characteristics associated with non-rupture-related mechanisms are not identified by CT angiography. It will therefore not be possible to differentiate plaques likely to develop IFC-ACS from stable plaques.This publication has 49 references indexed in Scilit:
- Prologue: Detection of Vulnerable PlaqueJournal of the American College of Cardiology, 2006
- Noninvasive Coronary Angiography With Multislice Computed TomographyJAMA, 2005
- Pathologic assessment of the vulnerable human coronary plaqueHeart, 2004
- Feasibility of assessment of coronary stent patency using 16-slice computed tomographyThe American Journal of Cardiology, 2004
- Relationship Between Coronary Artery Remodeling and Plaque VulnerabilityCirculation, 2002
- Plaque erosion is a major substrate for coronary thrombosis in acute myocardial infarctionPublished by BMJ ,1999
- The Composition of Coronary-Artery PlaquesThe New England Journal of Medicine, 1997
- Coronary Risk Factors and Plaque Morphology in Men with Coronary Disease Who Died SuddenlyThe New England Journal of Medicine, 1997
- Coronary Plaque Erosion Without Rupture Into a Lipid CoreCirculation, 1996
- Coronary arterial remodeling studied by high-frequency epicardial echocardiography: An early compensatory mechanism in patients with obstructive coronary atherosclerosisJournal of the American College of Cardiology, 1991