Abstract 10780: Plaque Disruption Identified by Coronary CTA in Acute Coronary Syndrome Versus Stable Clinical Presentations
Background: The ability of coronary CT angiography (CTA) to detect plaque disruption has been recently validated. This study was performed to delineate the frequency of CTA-identified disrupted plaques in acute coronary syndrome (ACS) versus stable patients.
Methods: We identified those undergoing CTA followed by invasive coronary angiography (ICA) within 60 days. Quantitative 3-vessel CTA lesion analysis was performed on all plaques to assess total volume, low attenuation plaque volume (LAP, <50 HU), and remodeling index. Plaques were further assessed for CTA features of disruption, including ulceration and intra-plaque dye penetration (IDP). ICA was used to determine the culprit status of plaques analyzed by CTA. Patients undergoing CTA for evaluation of ACS were compared to stable patients for the frequency of plaque disruption by CTA.
Results: In 145 patients (94 ACS; 51 stable), 679 plaques were analyzed by CTA. CTA identified features of disruption in 177 lesions (26 %), including ulceration in 86 (13 %) and IDP in 125 (18 %). Compared to non-disrupted lesions, disrupted plaques were more voluminous (242 mm3 ± 300 mm3 vs 125 mm3 ± 101 mm3, p <0.001), more often positively remodeled (92 % vs 67 %, p <0.001), contained more LAP (74 mm3 ± 136 mm3 vs 20 mm3 ± 18 mm3, p <0.001), and were more often culprits by ICA (38 % vs 8 %, p <0.001). There was no difference in the number of plaques in ACS and stable patients (4.7 ± 2.1 vs 4.7 ± 2.5, p = 0.93). At least one plaque with CTA features of disruption was identified in 78 % of ACS patients and in 33 % of stable patients (p<0.001) (Figure). CTA disrupted plaques accounted for a greater proportion of total lesions in ACS versus stable patients (33.6% vs 12.9%, p<0.001).
Conclusions: CTA identifies features of plaque disruption more commonly in ACS versus stable patients. Such lesions were more voluminous, positively remodeled, and contain more LAP than non-disrupted lesions.
- © 2011 by American Heart Association, Inc.