Assessing Culprit Lesions and Active Complex Lesions in Patients With Early Acute Myocardial Infarction by Multidetector Computed Tomography

Abstract

on-invasive assessment of angiographic culprit lesions in patients after acute myocardial infarction (AMI) remains challenging. 1,2 However, identification of these lesions would improve risk assessment and further management for patients after AMI. 3 In comparative studies with intracoronary ultrasound (ICUS), multidetector row computed tomography (MDCT) provides an accurate identification of coronary plaque crosssectional area, vessel size and coronary remodeling. [4][5][6] Furthermore, MDCT density values measured within plaques reflect echogenity and plaque composition. 4 MDCT has a high accuracy for the detection of significant coronary artery disease in patients with stable angina. 7 Furthermore, MDCT has been shown to be safe and accurate in assessing the severity of the infarct-related artery and the number of diseased vessels during the first week after AMI. [8][9][10][11] However, there is scarce published data on plaque texture evaluated by 64-slice MDCT in patients early after AMI. In this prospective study, we focus on MDCT to predict culprit lesions and identify multiple complex lesions in patients early after first AMI. Methods PatientsOne hundred and twenty-eight consecutive patients with first non-ST elevation AMI were admitted to our hospital. Diagnosis of non-ST elevation AMI was made on the basis of typical anginal pain lasting more than 30 min, new electrocardiographic change that included ST-segment depression ≥0.1 mV in ≥2 contiguous electrocardiographic leads, Q wave or other ST/T changes lasting more than 48 h, peak creatine kinase more than 2 times the upper limit of normal, and wall motion abnormalities by echocardiography.We excluded 25 of 128 patients according to our criteria, including: cardiogenic shock (2 patients), clinical signs of severe heart failure (4 patients), chronic atrial fibrillation (2 patients), allergy history to contrast (2 patients), bronchial asthma (1 patient), persistent chest pain undergoing rescue angioplasty (3 patients), refuse to participate in the study (3 patients), serum creatinine clearance below 70 ml/min (2 patients), motion artifacts (2 patients) and heavy calcifiCirc J 2008; 72: 1806 -1813 (Received February 22, 2008; revised manuscript received June 1, 2008; accepted June 24, 2008; released online September 24, 2008 Assessing Culprit Lesions and Active Complex Lesions in Patients With Early Acute Myocardial Infarction by Multidetector Computed TomographyWei-Chun Huang, MD* , **; Ming-Ting Wu, MD** , † ; Kuan-Rau Chiou, MD* , **; Guang-Yuan Mar, MD*; Shih-Hung Hsiao, MD*; Shih-Kai Lin, MD*; Tung-Cheng Yeh, MD*; Yi-Luan Huang, MD † ; Hsiang-Chiang Hsiao, MD* , **; Doyal Lee, MD*; Chuen-Wang Chiou, MD* , **; Shoa-Lin Lin, MD* , **; Chun-Peng Liu, MD* , ** Background Accurate, non-invasive characterization of culprit lesions in patients after acute myocardial infarction (AMI) remains challenging. In this prospective study, multidetector row computed tomography (MDCT) is used to assess culprit and active complex lesions in patients early after AMI. ...

Correlation between coronary computed tomographic angiography and fractional flow reserve

“…The significant correlations between plaque volume, plaque burden and FFR observed in our study indicate that plaque imaging with MDCT is feasible. Although these values were not independent factors to determine an abnormal FFR in multivariate regression analysis, characterization of plaque size and composition along with remodeling index may be important for the identification of the vulnerable plaque [9,10,[35][36][37].…”

Detection of Myocardial Ischemia Using 64-Slice MDCT

“…The current-generation 64-slice scanners allow rapid scanning of the cardiac anatomy, require minimal patient cooperation and have improved image quality and high diagnostic accuracy for coronary artery stenosis. [1][2][3][4][5][6] Recent studies report that the myocardial enhancement pattern of early defect and late enhancement on 64-slice MDCT enables non-invasive assessment of myocardial viability in acute myocardial infarction. [7][8][9] The first-pass imaging of MDCT using pharmacological stress has recently been used to assess myocardial perfusion quantitatively; however, detection of myocardial ischemia at rest using cardiac computed tomography (CT) alone has yet to be elucidated.…”

Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data in NSTEMI acute coronary syndrome and influence of gender and risk factors

“…In questo caso il confi ne tra ACS e dolore toracico non coronarico può essere meno defi nito ed è in questa categoria di pazienti che una metodica diagnostica affi dabile sarebbe auspicabile. La CTCA ha mostrato di avere un potenziale notevole in questa categoria di pazienti [2,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. a greater prevalence of RF among men (mean 2.7±0.9 vs. women 1.3±1.5; in particular, hypertension, dyslipidaemia, smoking, family history), whereas a higher calcium score was observed among women (men 375±340 vs. women 723±690).…”

“…Tuttavia, l'introduzione di nuovi hardware e software in grado di fornire adeguata qualità di immagine utilizzando il triggering prospettico basato sul segnale ECG consentono di portare i valori di dose al di sotto dei 5 mSv [9][10][11][12]. Una limitazione dello studio deriva dal design del registro che non offre le stesse carattedemonstrated signifi cant potential in this group of patients [2,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33].…”

“…Acute coronary syndrome (ACS) is a clinical situation in which the short times of performing conventional coronary angiography (CAG) and immediate revascularisation can be crucial [2,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. However, ACS is characterised by at least two major clinical presentations: ACS with elevated ST segment (STEMI) and ACS without elevated ST segment (NSTEMI) [34,35].…”