The Association Between Plaque Characterization by CT Angiography and Post-Procedural Myocardial Infarction in Patients With Elective Stent Implantation

Uetani, Tadayuki; Amano, Tetsuya; Kunimura, Ayako; Kumagai, S.; Ando, Hirohiko; Yokoi, Kohei; Yoshida, Tomohiro; Kato, Bunichi; Kato, Masataka; Marui, Nobuyuki; Nanki, Michio; Matsubara, Tatsuaki; Ishii, Hideki; Izawa, Hideo; Murohara, Toyoaki

doi:10.1016/j.jcmg.2009.09.016

Cited by 63 publications

(49 citation statements)

References 38 publications

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“…This pathophysiologic mechanism is supported by direct observations documenting lipid debris in fatal cases of distal embolization 26 and by recent findings obtained with various techniques, including NIRS, that the extent of lipid core in the vessel wall is diminished after balloon inflation. 17,18,36,37 The present study demonstrates a high relative risk of periprocedural MI in lesions with a maxLCBI 4 mm Ն500, a quantitative measure determined on-line by the NIRS system that does not require subjective operator interpretation or postprocedure analysis.…”

Section: Intracoronary Imaging and Lcpmentioning

confidence: 62%

Detection of Lipid-Core Plaques by Intracoronary Near-Infrared Spectroscopy Identifies High Risk of Periprocedural Myocardial Infarction

Goldstein

Maini

Dixon

et al. 2011

Circ: Cardiovascular Interventions

199

136

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Background-Percutaneous coronary intervention (PCI) is associated with periprocedural myocardial infarction (MI) in3% to 15% of cases (depending on the definition used). In many cases, these MIs result from distal embolization of lipid-core plaque (LCP) constituents. Prospective identification of LCP with catheter-based near-infrared spectroscopy (NIRS) may predict an increased risk of periprocedural MI and facilitate development of preventive measures. Methods and Results-The present study analyzed the relationship between the presence of a large LCP (detected by NIRS) and periprocedural MI. Patients with stable preprocedural cardiac biomarkers undergoing stenting were identified from the COLOR Registry, an ongoing prospective observational study of patients undergoing NIRS before PCI. The extent of LCP in the treatment zone was calculated as the maximal lipid-core burden index (LCBI) measured by NIRS for each of the 4-mm longitudinal segments in the treatment zone. A periprocedural MI was defined as new cardiac biomarker elevation above 3ϫ upper limit of normal. A total of 62 patients undergoing stenting met eligibility criteria. A large LCP (defined as a maxLCBI 4 mm Ն500) was present in 14 of 62 lesions (22.6%), and periprocedural MI was documented in 9 of 62 (14.5%) of cases. Periprocedural MI occurred in 7 of 14 patients (50%) with a maxLCBI 4 mm Ն500, compared with 2 of 48 patients (4.2%) patients with a lower maxLCBI 4 mm (Pϭ0.0002). Conclusions-NIRS

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Section: Intracoronary Imaging and Lcpmentioning

confidence: 62%

Detection of Lipid-Core Plaques by Intracoronary Near-Infrared Spectroscopy Identifies High Risk of Periprocedural Myocardial Infarction

Goldstein

Maini

Dixon

et al. 2011

Circ: Cardiovascular Interventions

199

136

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“…24 We 36 Uetani et al demonstrated that PMI was associated with the volume and fraction of LAP by MDCT. 37 We demonstrated that a CT attenuation value <55 Hounsfield units, PR (remodeling index >1.05) and spotty calcification were significant predictors of PMI; the presence of all 3 CT characteristics showed a high PPV of 94%, and their absence showed a high NPV of 90%. 38 Kodama et al demonstrated that CCTA-verified circumferential plaque calcification with LAP and PR were determinants of slowflow phenomenon during PCI.…”

Section: Assessment Of Coronary Vulnerable Plaquementioning

confidence: 71%

Role of Cardiac Multidetector Computed Tomography Beyond Coronary Angiography

Sato

Aonuma

2015

Circ J

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712SATO A et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp for detecting coronary artery stenosis has been compared with ICA. Several studies have demonstrated the ability of CCTA to detect anatomically significant CAD with high negative predictive value (NPV). The CORE 64 study demonstrated that the patient-based diagnostic accuracy of quantitative CCTA for detecting stenoses ≥50% according to ICA revealed an area under the curve (AUC) of 0.93, with sensitivity of 85%, specificity of 90%, positive predictive value (PPV) of 91%, and NPV of 83%. 7 The 64-slice CCTA is accurate in identifying coronary stenoses and characterizing disease severity in symptomatic patients who have coronary artery calcium scores (CACS) <600. Given its PPV of 91% and NPV of 83%, 64-slice CCTA cannot replace conventional ICA. The substudy of CORE 64 showed that the AUC for diagnostic accuracy was similar (0.93, 0.92, and 0.93, respectively) for patients with intermediate, high pretest probability for CAD, and known CAD, whereas the NPV was different (0.90, 0.83, and 0.50, respectively). For excluding obstructive CAD, CCTA was less effective in patients with calcium score ≥600 and high pretest probability for obstructive CAD. 13 In the CONFIRM study, the prevalence of observed CAD with either ≥50% diameter stenosis (CAD50) or 70% diameter stenosis (CAD70) was substantially lower than predicted by guideline probabilities in the overall population (18% vs. 51% for CAD50, 10% vs.ultidetector computed tomography (MDCT) is well established for more precise evaluation of coronary stenosis relative to electron-beam CT. 1-3 Multicenter studies have confirmed the accuracy of 64-slice MDCT for directly visualizing and detecting coronary artery stenoses in patients with suspected coronary artery disease (CAD). 4-7 Furthermore, dual-source CT (DSCT), 256-slice, and 320-detector scanner were developed to significantly improve scan times, volume coverage, and spatial resolution. 8-12 With improvement in the technical aspects of coronary computed tomography angiography (CCTA), clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology, myocardial perfusion imaging (MPI), and patient outcomes. In this review, we discuss the role of cardiac MDCT beyond coronary angiography, including a comparison with other currently available imaging modalities used to examine atherosclerotic plaque and myocardial perfusion. Diagnosis of CAD Role of Cardiac Multidetector Computed Tomography Beyond Coronary AngiographyAkira Sato, MD; Kazutaka Aonuma, MD, PhDCardiac multidetector computed tomography (MDCT) has become a useful noninvasive modality for anatomical imaging of coronary artery disease (CAD). Currently, the main clinical advantage of coronary computed tomography angiography (CCTA) appears to be related to its high negative predictive value at low or intermediate pretest probability for CAD. With the development of technical aspects of MDCT, clinica...

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“…15, 24 Recently, we have reported that coronary plaque with a large LDP volume is related to post-procedural myocardial infarction in elective PCI cases. 18 A report suggests that the presence of a large LDP volume increases the incidence of a no-reflow phenomenon in patients undergoing PCI. 25 Therefore, much careful attention should be paid to the treatment of coronary plaque with a large LDP volume.…”

Section: Discussionmentioning

confidence: 99%

“…Using Color Code Plaque™ (GE Healthcare), as previously reported, 17 the volume of each component of coronary plaque within the ROI was measured automatically, based on the stratified CT density. As previously reported, 18 each plaque component and lumen (filled with contrast medium) were defined as follows: (1) low-density (~50 Hounsfield units [HU]); (2) moderate-density (50-150 HU); (3) lumen (150-500 HU); (4) high-density (500 HU~). The total plaque volume (TPV) [sum of volume of LDP, moderate-density plaque (MDP) and high-density plaque (HDP)] and the fraction of each plaque component, defined as the volume of each component divided by the TPV, were also estimated.…”

Section: Arai K Et Almentioning

confidence: 99%

Volumetric Analysis of Coronary Plaque Characterization in Patients With Metabolic Syndrome Using 64-Slice Multi-Detector Computed Tomography

Arai

Ishii

Amano

et al. 2010

Circ J

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The Association Between Plaque Characterization by CT Angiography and Post-Procedural Myocardial Infarction in Patients With Elective Stent Implantation

Cited by 63 publications

References 38 publications

Detection of Lipid-Core Plaques by Intracoronary Near-Infrared Spectroscopy Identifies High Risk of Periprocedural Myocardial Infarction

Detection of Lipid-Core Plaques by Intracoronary Near-Infrared Spectroscopy Identifies High Risk of Periprocedural Myocardial Infarction

Role of Cardiac Multidetector Computed Tomography Beyond Coronary Angiography

Volumetric Analysis of Coronary Plaque Characterization in Patients With Metabolic Syndrome Using 64-Slice Multi-Detector Computed Tomography

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