The patients demonstrating positively remodeled coronary segments with low-attenuation plaques on CT angiography were at a higher risk of ACS developing over time when compared with patients having lesions without these characteristics.

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CTA-verified HRP was an independent predictor of ACS. However, the cumulative number of ACS patients with HRP(-) was similar to patients with HRP(+). Additionally, plaque progression detected by serial CTA was an independent predictor of ACS.

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This preliminary study suggests that serial CTA evaluation of coronary plaques allows for the assessment of interval change in the plaque morphology. Statin treatment results in decreases in the plaque and necrotic core volume. The features known to be associated with plaque instability.

In contrast to the situation with RFC-ACS, distinct culprit lesion characteristics associated with non-rupture-related mechanisms are not identified by CT angiography. It will therefore not be possible to differentiate plaques likely to develop IFC-ACS from stable plaques.

PurposeArtificial neural networks (ANN) might help to diagnose coronary artery disease. This study aimed to determine whether the diagnostic accuracy of an ANN-based diagnostic system and conventional quantitation are comparable.MethodsThe ANN was trained to classify potentially abnormal areas as true or false based on the nuclear cardiology expert interpretation of 1001 gated stress/rest 99mTc-MIBI images at 12 hospitals. The diagnostic accuracy of the ANN was compared with 364 expert interpretations that served as the gold standard of abnormality for the validation study. Conventional summed stress/rest/difference scores (SSS/SRS/SDS) were calculated and compared with receiver operating characteristics (ROC) analysis.ResultsThe ANN generated a better area under the ROC curves (AUC) than SSS (0.92 vs. 0.82, p < 0.0001), indicating better identification of stress defects. The ANN also generated a better AUC than SDS (0.90 vs. 0.75, p < 0.0001) for stress-induced ischemia. The AUC for patients with old myocardial infarction based on rest defects was 0.97 (0.91 for SRS, p = 0.0061), and that for patients with and without a history of revascularization based on stress defects was 0.94 and 0.90 (p = 0.0055 and p < 0.0001 vs. SSS, respectively). The SSS/SRS/SDS steeply increased when ANN values (probability of abnormality) were >0.80.ConclusionThe ANN was diagnostically accurate in various clinical settings, including that of patients with previous myocardial infarction and coronary revascularization. The ANN could help to diagnose coronary artery disease.

ollowing the development of drug-eluting stents (DES) the interventional cardiologist seems to have overcome the nemesis of restenosis. The First-InMan study and a randomized comparison of a sirolimuseluting stent (SES) with a standard stent for coronary revascularization reported complete inhibition of restenosis in simple discrete lesions at 6 months. 1,2 However, recent randomized clinical trials using DES for lesions with lowor intermediate restenosis risk reported restenosis rates ranging from 2.3% to 16.7%. [3][4][5][6][7][8][9][10][11][12] Furthermore, the number of DES used and the stent length required for each lesion are both substantially increasing based on the recent recommended policy of full lesion coverage to avoid any potential injury at the stent edges. popularity of DES technologies worldwide, the precise mechanisms responsible for DES restenosis remain unclear. Several case reports have highlighted the occurrence of stent fracture (absence or deformity of a stent strut inside the stent) at follow-up, especially in patients experiencing restenosis with SES, however, the incidence of fracture and its impact on restenosis are poorly understood. [12][13][14][15][16][17][18] The purpose of this study was to investigate the predictors of restenosis following SES implantation and to determine the incidence and impact of stent fracture. We prospectively performed the SES implantation under intravascular ultrasound (IVUS) Guidance in Native coronary Artery Lesions (SIGNAL) study at the Fujita Health University hospital. Methods Study Design and EndpointsThe SIGNAL study was designed as a prospective, single-center, angiographic and IVUS follow-up study to evaluate the acute and late efficacy, as well as safety of deployment, of SES. The primary endpoint was angiographic restenosis. The principal clinical endpoint was a composite Circ J 2007; 71: 1669 -1677 (Received September 19, 2006 revised manuscript received July 5, 2007; accepted July 19, 2007 Although multivariate logistic regression analysis revealed that minimal lumen area (min-LA) post (p=0.027), total stent length (p=0.003) and diabetes (p=0.032) were significant independent predictors of restenosis, univariate analysis showed that stent fracture was more common in the restenosis than in the non-restenosis groups (p=0.001).Conclusions Although min-LA post by IVUS, total stent length by QCA and diabetes are independent predictors for angiographic restenosis, stent fracture occurred in 4 lesions (2.4%) and all of them resulted in restenosis (31% of the restenosis). The impact of stent fracture and its potential role in the development of restenosis deserves further study. (Circ J 2007; 71: 1669 -1677)