Abstract 10930: Impact of C-reactive Protein and MDCT-assessed Pan-coronary Plaque Morphology on Slow Flow Phenomenon in Acute Coronary Syndrome
Background: It was reported that patients with acute coronary syndrome (ACS) frequently have vulnerable plaques in the remote coronary arteries, suggesting ACS is a part of the pan-coronary process and systemic inflammation. MDCT allows us to assess not only culprit lesion but also whole coronary trees. However in patients with ACS, the impact of plaque morphology in remote coronary arteries and C-reactive protein (CRP) on the occurrence of slow flow phenomenon (SF) during PCI is still unclear.
Methods: Consecutive 116 patients (69±9 years, 78% males) with acute coronary syndrome diagnosed by 128-slice dual source MDCT before coronary interventions were enrolled. Non-culprit lesions were defined as plaques with more than 25% diameter stenosis measured by quantitative angiography that had not been treated. The CT value of plaque and plaque morphology in culprit and non-culprit lesions and serum CRP level were compared between patients with and without SF during PCI.
Results: Thirty six patients (31 %) had SF during PCI. Serum CRP level was significantly higher in patients with SF (median: 151.0μg/ml IQR: [82.3-250.0μg/ml] vs. 58.5μg/ml [28.5-167.3μg/ml], p=0.001). Based on ROC analysis, cut-off value of CRP for the prediction of SF was defined as 75.0μg/ml. The prevalence of Napkin-ring sign (NRS) in culprit lesion and low attenuation plaque (LAP) in non-culprit lesion were significantly higher in patient with SF (63.9% vs. 22.5%, p<0.001 and 42.9% vs. 8.6%, p<0.001, respectively). Using multivariate analysis, NRS in culprit lesion, LAP in non-culprit lesion and higher level of CRP were independent predictors of SF during PCI (Table).
Conclusion: Assessment of serum CRP level and plaque morphology of non-culprit lesion assessed by MDCT might allow us to predict SF during PCI in patients with ACS more accurately.
- © 2013 by American Heart Association, Inc.