Coronary Computed Tomography Angiography-Derived Plaque Quantification in Patients With Acute Coronary Syndrome

Area of Science:

• Cardiovascular Imaging
• Radiology
• Interventional Cardiology

Background:

• Acute coronary syndrome (ACS) diagnosis relies on clinical presentation and risk factors.
• Coronary computed tomography angiography (cCTA) offers detailed visualization of atherosclerotic plaque.
• Differentiating ACS from stable coronary artery disease (CAD) is crucial for timely and appropriate treatment.

Purpose of the Study:

• To evaluate the discriminatory value of quantitative atherosclerotic plaque markers from cCTA.
• To compare these markers between patients with first ACS and stable CAD.
• To assess the diagnostic performance of cCTA markers for identifying ACS.

Main Methods:

• Retrospective analysis of 40 patients with first ACS and matched controls with stable CAD.
• Coronary computed tomography angiography (cCTA) followed by invasive coronary angiography.
• Derivation and comparison of quantitative plaque markers (volume, burden, remodeling index, lesion length, napkin-ring sign, scores) on per-lesion and per-patient levels.

Main Results:

• Patients with ACS exhibited significantly higher obstructive CAD, segment stenosis score, segment involvement score, noncalcified plaque volume, lesion length, and remodeling index.
• Culprit lesions in ACS patients showed higher plaque burden, total plaque volume, noncalcified plaque volume, remodeling index, lesion length, and napkin-ring sign prevalence compared to non-culprit lesions.
• Receiver-operating characteristic (ROC) analysis demonstrated high discriminatory power for cCTA markers (AUC 0.92 per-patient, 0.88 per-lesion).

Conclusions:

• Quantitative cCTA-derived plaque markers possess significant discriminatory value for identifying ACS.
• These markers are valuable both on a per-patient and per-lesion basis.
• Combining cCTA plaque markers with the Framingham risk score enhances the ability to identify ACS patients.