Relationship between patient presentation and morphology of coronary atherosclerosis by quantitative multidetector computed tomography

Abstract

Aims Quantitative computed tomography (QCT) allows assessment of morphological features of coronary atherosclerosis. We aimed to test the hypothesis that clinical patient presentation is associated with distinct morphological features of coronary atherosclerosis. Methods and results A total of 1652 participants, representing a spectrum of clinical risk profiles [787 asymptomatic individuals from the general population, 468 patients with acute chest pain without acute coronary syndrome (ACS), and 397 patients with acute chest pain and ACS], underwent multidetector computed tomography. Of these, 274 asymptomatic individuals, 254 patients with acute chest pain without ACS, and 327 patients with acute chest pain and ACS underwent QCT to assess coronary plaque volumes and proportions of dense calcium (DC), fibrous, fibro fatty (FF), and necrotic core (NC) tissue. Furthermore, the presence of vulnerable plaques, defined by plaque volume and tissue composition, was examined. Coronary plaque volume increased significantly with worsening clinical risk profile [geometric mean (95% confidence interval): 148 (129–166) mm3, 257 (224–295) mm3, and 407 (363–457) mm3, respectively, P < 0.001]. Plaque composition differed significantly across cohorts, P < 0.0001. The proportion of DC decreased, whereas FF and NC increased with worsening clinical risk profile (mean proportions DC: 33%, 23%, 23%; FF: 50%, 61%, 57%; and NC: 17%, 17%, 20%, respectively). Significant differences in plaque composition persisted after multivariable adjustment for age, gender, body surface area, hypertension, statin use at baseline, diabetes, smoking, family history of ischaemic heart disease, total plaque volume, and tube voltage, P < 0.01. Conclusion Coronary atherosclerotic plaque volume and composition are strongly associated to clinical presentation.

Reproducibility of quantitative coronary computed tomography angiography in asymptomatic individuals and patients with acute chest pain

“…This finding is most likely due to differences in plaque composition and disease burden between the investigated subpopulations. It has been shown that coronary atherosclerotic plaque volume and composition are strongly associated to clinical presentation and several studies have previously reported increased total non-calcified plaque volume and low attenuation plaque volume in patients with ACS compared to patients with stabile angina and asymptomatic individuals [6,7,24].…”

Society of Cardiovascular Computed Tomography / North American Society of Cardiovascular Imaging – Expert Consensus Document on Coronary CT Imaging of Atherosclerotic Plaque

“…27 Patients with acute chest pain diagnosed with ACS had increased atherosclerotic plaque volume, notably fibro-fatty and necrotic core plaque, when compared to those with stable disease. 92 The ICONIC (Incident COroNary Syndromes Identified by Computed Tomography) casecontrol series is the largest (n=234 matched case and control pairs) to evaluate quantitative CCTA precursors of ACS. In ICONIC, both HRP features and quantitative assessment of fibrofatty and necrotic core plaque volume was more often associated with patient experiencing ACS; independent of coronary stenosis.…”

Computed tomography coronary angiography in non-ST-segment elevation myocardial infarction

“… 66 In fact, compared with asymptomatic patients, those with acute chest pain have a greater volume of total and low-attenuation plaque, particularly those with non-ST-segment elevation myocardial infarction. 67 In the RAPID-CTCA trial, the burden of total, noncalcified, and low-attenuation plaque were the strongest predictors of death or myocardial infarction at one year, independent of GRACE score and the presence of diameter stenosis ≥70%, among patients with suspected acute coronary syndrome. 68 Furthermore, CTCA along with quantitative plaque analysis potentially helps discriminate acute coronary syndrome by characterising adverse plaque features.…”