Abstract 309: A Computed Tomography Based Score to Identify Culprit Coronary Lesions Among Patients With Acute Chest Pain and Low to Intermediate Likelihood of Acute Coronary Syndrome
Background: Higher remodeling index (RI), spotty calcifications (Ca), and larger plaque area have been previously described as features of culprit coronary plaques in patients (pts) with acute coronary syndrome (ACS). We hypothesized that a score including those features may identify culprit lesions among patients with acute chest pain, non-diagnostic ECG and negative initial biomarkers, who have significant coronary disease on computed tomography coronary angiography (CT).
Methods: From a cohort of 368 pts who presented with acute chest pain, non-diagnostic ECG and negative initial biomarkers, and underwent CT (ROMICAT), we analyzed data from 34 pts, in which CT showed a >50% stenosis. Caregivers were blinded to the results of CT. We determined degree and length of stenosis, plaque area and volume, RI, CT attenuation of plaque, and presence of spotty Ca. Differences between pts with and without ACS were determined using Wilcoxon and Fisher’s tests. Logistic regression was performed to test the diagnostic value of three scores based on plaque characteristics as well as the TIMI score with the outcome of ACS. Model fit was assessed using c-statistics.
Results: Stenotic lesions were longer, had higher RI, and larger volume of low density plaque in pts with ACS (Table⇓). While TIMI score did not predict ACS (OR 1.1, 95%CI 0.6 –2.2, AUC 0.57), score A (RI+spotty Ca: OR 4.1, 95%CI 1.3–12.8, AUC 0.76) and score B (RI+spotty Ca+plaque area: OR 4.0, 95%CI 1.5–10.7, AUC 0.81) predicted ACS. Adding stenosis length and volume further improved diagnostic value (score C RI+spotty Ca+plaque area+stenosis length+volume of <90HU plaque: OR 3.5, 95%CI 1.5– 8.2, AUC 0.87).
Conclusions: Among pts who present with acute chest pain, but inconclusive initial ED evaluation and in whom a significant stenosis is detected by CT, a lesion score including RI, spotty Ca, plaque area, low HU plaque volume, and stenosis length has good diagnostic value to prospectively identify culprit lesions and ACS.