Characterization of Noncalcified Coronary Plaques and Identification of Culprit Lesions in Patients With Acute Coronary Syndrome by 64-Slice Computed Tomography

Abstract

Sixty-four-slice CT angiography demonstrates a higher prevalence of NCPs with vulnerable characteristics in patients with ACS as compared with stable clinical presentation.

Predictive Value of Adiponectin in Patients with Multivessel Coronary Atherosclerosis Detected on Computed Tomography Angiography

“…If a noninvasive method for predicting ACS was available, highrisk patients requiring aggressive preventive measures (i.e., evidence-based medication) could be identified. CTCA is one of the most promising noninvasive tools for predicting cardiac events via the direct assessment of coronary plaque 32,33) . However, current guidelines for the noninvasive diagnosis of coronary artery lesions do not recommend the use of CTCA in asymptomatic persons for detecting CAD or screening for atherosclerosis, especially noncalcified plaque (Class Ⅲ, Level of Evidence: C) 34,35) .…”

Plaque Quantification by Coronary CT and Intravascular Ultrasound Identifies a Low CT Density Core as a Marker of Plaque Instability in Acute Coronary Syndromes

“…8,9) However, although these studies have demonstrated an association between the presence of different 10) In most ACS cases, CCTA plaque quantifi cation demonstrates a mixed composition of the coronary plaques, containing variable proportions of a lipid-reach core with a low CT density (with mean attenuation values reported in a range between 11 and 99 Hounsfi eld units (HU)), a fi brous component with higher CT densities (with mean attenuation values reported in a range between 77 and 121 HU), and calcium. [11][12][13] While many studies published on the topic of CT plaque characterization have demonstrated the presence of a low-density core (LDC) containing lipid-reach atheroma in the culprit lesions, 14,15) quantitative assessment of this LDC is almost totally lacking in all these studies. We previously reported that unstable plaques are characterized by larger volumes of lowdensity lipid-reach cores and that a critical volume of 6.0 mm 3 plaque with CT density < 30 HU could differentiate between culprit and non-culprit lesions in patients with ACS, with a sensitivity of 100% and a specifi city of 65.8% (area under the curve 0.89).…”

Coronary Artery CT Low-Density Plaque Area and Its Ratio to the Whole Area of a Non-Calcified Plaque at the Culprit Lesion in Patients With Unstable and Stable Coronary Artery Disease

“…[18][19][20] Characterization of the culprit lesion by 64-slice CTCA may therefore provide clues to distinguish potentially vulnerable plaques from stable ones. The coronary plaque area detected by 64-slice CTCA in patients with ACS and SAP has been evaluated previously, 15) but there are no reports on the evaluation of the CT low-density plaque area in patients with ACS and SAP. The purpose of the present study was to quantitatively evaluate the CT low-density plaque area in patients with unstable angina pectoris (UAP) and SAP using 64-slice CTCA.…”

“…[11][12][13] Culprit atherosclerotic lesions in ACS patients showed complex findings such as spotty calcification, lipid-rich plaques, and positive vascular remodeling, whereas the culprit lesions in SAP patients showed these features less frequently. 14,15) Discrete lesions detected by multislice CT were found more in patients with unstable angina pectoris or a STEMI, while diffuse and mixed lesions were detected more often in patients with stable angina. 16) Regarding evaluation of plaque composition, an invasive method called virtual histology IVUS showed that the noncalcified plaques of the culprit lesions in ACS patients had greater amounts of necrotic core component and smaller amounts of "fibrofatty" component compared to the target lesions in SAP patients.…”