TY - JOUR
T1 - Comparing culprit lesions in ST-segment elevation and non-ST-segment elevation acute coronary syndrome with 64-slice multidetector computed tomography
AU - Huang, Wei Chun
AU - Liu, Chun Peng
AU - Wu, Ming Ting
AU - Mar, Guang Yuan
AU - Lin, Shih Kai
AU - Hsiao, Shih Hung
AU - Lin, Shoa Lin
AU - Chiou, Kuan Rau
N1 - Funding Information:
The authors wish to thank RT Chuo Chiung-Chen, Chen Jian-Shyong and Liang Lo-Sha for patient scanning, RN Yuan Su-Chi, Chien Ming-Chu and Chang Chuen-Yin for patient preparation, and Research assistants Yu-Ying Lin for data management. This study was supported by the Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Grant No. VGHKS 96-09, 96-010 and 96-011 and National Science Council, Taiwan, NSC 95-2314-B-075B-004.
Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/1/1
Y1 - 2010/1/1
N2 - Background: Classifying acute coronary syndrome (ACS) as ST elevation ACS (STE-ACS) or non-ST elevation ACS (NSTE-ACS) is critical for clinical prognosis and therapeutic decision-making. Assessing the differences in composition and configuration of culprit lesions between STE-ACS and NSTE-ACS can clarify their pathophysiologic differences. Objective: This study focused on evaluating the ability of 64-slice multidetector computed tomography (MDCT) to investigate these differences in culprit lesions in patients with STE-ACS and NSTE-ACS. Methods: Of 161 ACS cases admitted, 120 who fit study criteria underwent MDCT and conventional coronary angiography. The following MDCT data were analyzed: calcium volume, Agatston calcium scores, plaque area, plaque burden, remodeling index, and plaque density. Results: The MDCT angiography had a good correlation with conventional coronary angiography regarding the stenotic severity of culprit lesions (r = 0.86, p < 0.001). The STE-ACS culprit lesions (n = 54) had significantly higher luminal area stenosis (78.6 ± 21.2% vs. 66.7 ± 23.9%, p = 0.006), larger plaque burden (0.91 ± 0.10 vs. 0.84 ± 0.12, p = 0.007) and remodeling index (1.28 ± 0.34 vs. 1.16 ± 0.22, p = 0.021) than those with NSTE-ACS (n = 66). The percentage of expanding remodeling index (remodeling index >1.05) was significantly higher in the STE-ACS group (81.5% vs. 63.6%, p = 0.031). The patients with STE-ACS had significantly lower MDCT density of culprit lesions than patients with NSTE-ACS (25.8 ± 13.9 HU vs. 43.5 ± 19.1 HU, p < 0.001). Conclusions: Sixty-four-slice MDCT can accurately evaluate the stenotic severity and composition of culprit lesions in selected patients with either STE-ACS or NSTE-ACS. Culprit lesions in NSTE-ACS patients had significantly lower luminal area stenosis, plaque burden, remodeling index and higher MDCT density, which possibly reflect differences in the composition of vulnerable culprit plaques and thrombi.
AB - Background: Classifying acute coronary syndrome (ACS) as ST elevation ACS (STE-ACS) or non-ST elevation ACS (NSTE-ACS) is critical for clinical prognosis and therapeutic decision-making. Assessing the differences in composition and configuration of culprit lesions between STE-ACS and NSTE-ACS can clarify their pathophysiologic differences. Objective: This study focused on evaluating the ability of 64-slice multidetector computed tomography (MDCT) to investigate these differences in culprit lesions in patients with STE-ACS and NSTE-ACS. Methods: Of 161 ACS cases admitted, 120 who fit study criteria underwent MDCT and conventional coronary angiography. The following MDCT data were analyzed: calcium volume, Agatston calcium scores, plaque area, plaque burden, remodeling index, and plaque density. Results: The MDCT angiography had a good correlation with conventional coronary angiography regarding the stenotic severity of culprit lesions (r = 0.86, p < 0.001). The STE-ACS culprit lesions (n = 54) had significantly higher luminal area stenosis (78.6 ± 21.2% vs. 66.7 ± 23.9%, p = 0.006), larger plaque burden (0.91 ± 0.10 vs. 0.84 ± 0.12, p = 0.007) and remodeling index (1.28 ± 0.34 vs. 1.16 ± 0.22, p = 0.021) than those with NSTE-ACS (n = 66). The percentage of expanding remodeling index (remodeling index >1.05) was significantly higher in the STE-ACS group (81.5% vs. 63.6%, p = 0.031). The patients with STE-ACS had significantly lower MDCT density of culprit lesions than patients with NSTE-ACS (25.8 ± 13.9 HU vs. 43.5 ± 19.1 HU, p < 0.001). Conclusions: Sixty-four-slice MDCT can accurately evaluate the stenotic severity and composition of culprit lesions in selected patients with either STE-ACS or NSTE-ACS. Culprit lesions in NSTE-ACS patients had significantly lower luminal area stenosis, plaque burden, remodeling index and higher MDCT density, which possibly reflect differences in the composition of vulnerable culprit plaques and thrombi.
KW - Acute coronary syndrome
KW - Angiography
KW - Computed tomography
KW - Contrast media
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U2 - 10.1016/j.ejrad.2008.09.024
DO - 10.1016/j.ejrad.2008.09.024
M3 - Article
C2 - 19004589
AN - SCOPUS:73549092731
SN - 0720-048X
VL - 73
SP - 74
EP - 81
JO - European Journal of Radiology
JF - European Journal of Radiology
IS - 1
ER -