Abstract 710: Assessment of Plaque Vulnerability by 64-Row Multidetector Computer Tomography (64-MDCT) Coronary Angiography
Background It is well known that acute coronary syndromes (ACS) frequently develop from previously nonsevere lesion from studies using conventional coronary angiography (CAG). 64-MDCT coronary angiography (CTA) is widely accepted and routinely used as a screening tool in patients with chronic myocardial ischemia. In serial analysis of those patients with CTA and CAG, angiographic discrepancy is often observed and angiographical findings of ACS-related lesions in future could be different from those detected by CAG.
Methods and Results To elucidate angiographic characteristics of future ACS-related lesions in the 64-MDCT era, consecutive 736 patients who underwent CTA between January 2007 and July 2008 were tracked for 12±3 months. From the time of CTA to August 2008, 12 of those patients had ACS and emergent CAG was done immediately after the onset. Angiographic characteristics ACS-related lesions detected by prior CTA were analyzed. CAG revealed 9 deep intimal ruptures and 3 superficial erosions as ACS-related lesions. ACS-related plaques were detected as relatively significant stenosis being slightly different to the previous studies with serial CAG. The presence of plaque rupture was associated with significantly greater CT density (rupture 89±26 HU, erosion 194±68 HU; p<0.02) and superficial calcified nodule as compared with that of erosions. Furthermore length of culprit lesions tended to be shorter in plaque rupture.
Conclusions Coronary angiography with 64-MDCT could be useful to predict future ACS sites by assessing lesion calcification, lesion length, CT density and severity of stenosis. More cases with ACS, longer follow-up period and more rows of detector are needed to raise the diagnostic value of CTA.