Abstract 12179: Clinical Disposition of Subjects More Likely to Demonstrate High-Risk Plaques as Identified CT Coronary Angiography
Background: Atherosclerotic plaques with positive vessel remodeling (PR, index>1.1) and low-attenuation plaque (LAP, <30HU) (2-feature-positive plaques: 2FPP), in CT coronary angiography (CTCA) are considered at high-risk of development of subsequent acute coronary events. More than 11% of patients with 2FPP develop acute events within ensuing 1 year. We evaluated clinical background of patients with 2FPP in CTCA.
Methods: Of 7585 consecutive patients who underwent coronary 64 or 320-slice MDCT angiography at our center for suspected coronary artery disease due to chest symptom or other reasons, such as one or more coronary risk factors, ECG abnormality, preoperative evaluation; 657 patients with previous myocardial infarction, 1473 patients with percutaneous interventions and 408 patients with other reasons (including unacceptable image quality) were excluded. In the remaining 5047patients (M/F=2490/2557, 65±12yrs) age, gender, coronary risk factor (hypertension-HT, diabetes- DM, hyperlipidemia- HL, smoking), body mass index, history of cerebral infarction, as also the presence of angina and abnormal rest ECG findings, were investigated as predictors for 2FPP by multivariate analysis using logistic regression analysis.
Results: 2FPP were observed in 361 patients (7%). Logistic regression analysis revealed significant predictor for 2FPP to be a male (HR: 2.579, 95%CI 1.971–3.374, p<0.0001), HL (1.339, 1.050–1.707, p=0.02), DM (1.983, 1.538–2.556, p<0.0001), history of cerebral infarction (1.697, 1.100–2.619, p=0.02). Presence or absence of chest pain and abnormal ECG findings were not a significant predictor; 88 (24%) 2FPP patients had no chest pain. Of the 88 asymptomatic patients, 57 did not show significant obstructive lesions and 36 patients had abnormal ECG findings; 6 patients had no risk factor, 30 patients had 1, 23 patients2, and 29 patients had more than 3 risk factors.
Conclusions: About a quarter of patients carrying 2FPP or high-risk plaques do not show chest pain and may constitute the basis of acute events as the first manifestation of coronary disease.Male, HL, DM and history of cerebral infarction were independent predictors of the presence of high-risk plaques.
- © 2010 by American Heart Association, Inc.