Abstract 13300: Quantitative Coronary Plaque Analysis on Coronary Computed Tomography Can Detect High-Risk Plaque Characteristics Associated with Acute Coronary Syndrome - Results from the ROMICAT II Trial
Introduction: Novel analytical methods in coronary computed tomography angiography (CCTA) permit quantitative assessment of coronary atherosclerotic plaque and detection of high-risk features. We determined the association of high-risk plaque features with the outcome of acute coronary syndrome (ACS) in patients with acute chest pain.
Methods: We studied 501 patients who presented to the emergency department with acute chest pain, negative troponin and electrocardiogram at the time of presentation, and were randomized to the CCTA arm of the ROMICAT II trial. Quantitative analysis was performed in 260 patients in whom coronary plaques were detected by visual assessment. Readers used a semi-automated software (QAngio, CT RE 2.0, MEDIS Medical Imaging Systems BV) to measure high-risk plaque features (volume of plaque with <60 HU, remodeling index, plaque burden) and minimal luminal area in all coronary plaques. The primary outcome of the study was ACS (myocardial infarction or unstable angina pectoris) as adjudicated by an external, independent clinical-events committee.
Results: The baseline characteristics and quantitative plaque analysis stratified by ACS are summarized in the Table. There were more men in the ACS group. In univariate analysis, patients with ACS had larger volume of plaque with 70%, and minimal luminal area <4 mm2. In multivariable regression analysis volume of plaque with <60 HU (OR 1.02 per mm3, 95% CI 1.00-1.03, p=0.05), number of plaques with positive remodeling (OR 1.4, 95% CI 1.06-1.84, p=0.02), and number of plaques with minimal luminal area <4 mm2 (OR 1.39, 95% CI 1.15-1.68, p=0.001) remained significant predictors of ACS.
Conclusions: Quantitative measures of high-risk plaque (volume of plaque with low HU <60HU, number of plaques with positive remodeling) are associated with ACS independently of minimal luminal area in patients with acute chest pain.
Author Disclosures: M. Ferencik: Research Grant; Significant; American Heart Association Fellow to Faculty Award. S.B. Puchner: None. M.T. Lu: None. P. Maurovich-Horvat: None. T. Mayrhofer: None. T. Liu: None. K. Ghemigian: None. P. Kitslaar: Employment; Significant; MEDIS. A. Broersen: None. U. Hoffmann: Research Grant; Significant; NIH U01HL092040 and U01HL092022.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.