Author + information
- Received June 13, 2005
- Revision received September 25, 2005
- Accepted November 9, 2005
- Published online April 18, 2006.
- Udo Hoffmann, MD⁎,⁎ (, )
- Fabian Moselewski, BS⁎,†,
- Koen Nieman, MD⁎,†,
- Ik-Kyung Jang, MD, PhD†,
- Maros Ferencik, MD, PhD⁎,
- Ayaz M. Rahman, MD⁎,
- Ricardo C. Cury, MD⁎,
- Suhny Abbara, MD⁎,
- Hamid Joneidi-Jafari, BS⁎,
- Stephan Achenbach, MD⁎,†,‡ and
- Thomas J. Brady, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Udo Hoffmann, Department of Radiology, Massachusetts General Hospital, 165 Charles River Plaza, Suite 400, Boston, Massachusetts 02114.
Objectives The purpose of this study was to assess morphology and composition of culprit and stable coronary lesions by multidetector computed tomography (MDCT).
Background Noninvasive identification of culprit lesions has the potential to improve noninvasive risk stratification in patients with acute chest pain.
Methods Thirty-seven patients with acute coronary syndrome (ACS) or stable angina underwent coronary 16-slice MDCT and invasive selective angiography. In all significant coronary lesions two observers measured the degree of stenosis, plaque area at stenosis, and remodeling index and assessed plaque composition. Differences between culprit lesions in patients with ACS and stable lesions in patients with ACS or stable angina were determined.
Results We analyzed 40 lesions with excellent image quality in 14 patients with ACS and 9 patients with stable angina. Culprit lesions in patients with ACS (n = 14) had significantly greater plaque area and a higher remodeling index than both stable lesions in patients with ACS (n = 13) and in patients with stable angina (n = 13) (17.5 ± 5.9 mm2vs. 9.1 ± 4.8 mm2vs. 13.5 ± 10.7 mm2, p = 0.02; and 1.4 ± 0.3 vs. 1.0 ± 0.4 vs. 1.2 ± 0.3, p = 0.04, respectively). The prevalence of non-calcified plaque was 100%, 62%, and 77%, respectively, and the prevalence of calcified plaque was 71%, 92%, and 85%, respectively, in culprit lesions in patients with ACS and in stable lesions in patients with ACS or stable angina.
Conclusions We introduce the concept of noninvasive detection and characterization of coronary atherosclerotic lesions in patients with ACS by MDCT. We identified differences in lesion morphology and plaque composition between culprit lesions in ACS and stable lesions in ACS or stable angina, consistent with previous intravascular ultrasound studies.
This work was supported in part by New York Cardiac Center, New York and Siemens Medical Solutions. Dr. Nieman was supported by the Interuniversity Cardiology Institute of the Netherlands. Dr. Ferencik was supported in part by National Institutes of Health Grant 1 T32 HL076136-02.
- Received June 13, 2005.
- Revision received September 25, 2005.
- Accepted November 9, 2005.
- American College of Cardiology Foundation