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Differences in coronary artery disease by CT angiography between patients developing unstable angina pectoris vs.

Christopher L Schlett1, John W Nance2, U Joseph Schoepf3

  • 1Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.

European Journal of Radiology
|May 20, 2014
PubMed

Insights

The extent of mixed coronary plaque on CT angiography predicts unstable angina pectoris (UAP) versus major adverse cardiac events (MACE). This finding helps differentiate cardiac event severity in patients with acute chest pain.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • CT angiography (CTA) is used for prognostic assessment in patients.
  • The predictive value of CTA-identified atherosclerosis for differentiating unstable angina pectoris (UAP) from major adverse cardiac events (MACE) remains unclear.

Purpose of the Study:

  • To investigate whether differences in atherosclerosis detected by CTA can predict the development of UAP versus MACE.
  • To determine if specific plaque characteristics on CTA are associated with distinct cardiac event trajectories.

Main Methods:

  • A cohort of 315 patients undergoing CTA for acute chest pain work-up was followed for at least 12 months.
  • CTA scans were analyzed for coronary plaque extent and composition, as well as stenosis.
  • Ordinal regression analysis was used to assess the association between plaque features and a 3-level outcome: no events, UAP, or MACE.

Main Results:

  • Patients who developed UAP showed higher overall atherosclerosis burden compared to those with no events.
  • The extent of mixed coronary plaque was significantly different between patients who experienced UAP and those who had MACE (p=0.02).
  • Higher extents of mixed plaque were associated with increased odds of more severe cardiac events, even after adjusting for confounders.

Conclusions:

  • The extent of mixed coronary plaque on CTA distinguishes between patients who develop UAP and those who experience MACE.
  • Mixed plaque morphology appears to be a more culprit lesion characteristic, indicating a higher risk of severe cardiac events.
Abstract

Keywords:
Computed tomographic angiographyMajor adverse cardiac eventsPartially calcified plaqueUnstable angina pectorisVulnerable plaque

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