Abstract 2624: An Analysis of CT Angiographic Patterns in Patients With vs. Without Acute Coronary Syndromes Presenting to the Emergency Department With Acute Chest Pain
Background: Cardiac multidetector computed tomography (MDCT) permits detection and quantification of coronary plaque. The aim of this study was to compare the presence and extent of coronary artery disease (CAD) as determined by MDCT in patients with and without acute coronary syndromes (ACS).
Methods: 103 patients with acute chest pain presenting to the Emergency Department (ED), with negative cardiac biomarkers and no ECG changes indicative for acute myocardial ischemia, underwent cardiac MDCT (Siemens Sensation 64, 64x0.6mm collimation, 330ms gantry rotation). The presence of coronary plaque was treated as a dichotomous outcome, and the extent of CAD was defined as number of
coronary segments with plaque, or
major coronary arteries with plaque detected by MDCT as assessed by two independent observers. The clinical outcome (ACS) was defined by an adjudicating committee using ACC criteria. Univariate associations between the presence and extent of CAD and the discharge diagnosis of ACS were examined using Student t-test for continuous and χ2 test for categorical variables.
Results: No subject in whom CAD was not detected (n=41) had an ACS event. The analysis was performed in the remaining 62 subjects (41 men, mean age 58±13 yrs) in whom CAD (coronary plaque) was detected by MDCT. The mean number of coronary segments with any plaque and calcified plaque per patient was higher in subjects with ACS (n=14) compared to subjects without ACS (n=48) (any plaque 9.1±4.5 vs 4.5±3.2, p<0.001; calcified plaque 8.1±3.2 vs 3.4±3.2, p<0.001). There was no significant difference in the number of non-calcified plaques between patients with and without ACS (3.1±2.9 vs 2.0±1.7, p=NS). There was a significant positive association between the presence of ACS and the number of major coronary arteries with plaque (ACS vs no ACS: 1 vessel 14% vs 33%, 2 vessels 7% vs 25%, and 3 vessels 78% vs 42%; p<0.01). The ratio of non-calcified to calcified plaques was not different between ACS and non-ACS group (0.6±0.7 vs 0.7±1.0, p=NS).
Conclusions: CT angiographic patterns are different between subjects with and without ACS in patients presenting to the ED with acute chest pain. Patients with ACS have a significantly higher plaque burden and more calcified plaque than subjects without ACS.