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Published on: August 28, 2018
Distinguishing Type 1 from Type 2 Myocardial Infarction by Using CT Coronary Angiography
Mohammed N Meah1, Anda Bularga1, Evangelos Tzolos1
1British Heart Foundation Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland (M.N.M., A.B., E.T., A.R.C., M.D., J.D.H., J.C., C.T., R.W., A.G., M.R.D., N.L.M., D.E.N., M.C.W.); Usher Institute, University of Edinburgh, Edinburgh, Scotland (A.G., N.L.M.); University Hospital Plymouth, Plymouth, England (C.R.); Faculty of Medicine, University of Southampton, Southampton, England (N.C.); University Hospital Southampton, Southampton, England (N.C.); Department of Cardiology, Milton Keynes University Hospital, School of Sciences and Medicine, University of Buckingham, Buckingham, England (A.K.); Torbay and South Devon NHS Foundation Trust, Torquay, England (D.F.); Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, Calif (P.J.S., D.D.); and Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, Scotland (D.E.N., M.C.W.).
Purpose:
To determine whether quantitative plaque characterization by using CT coronary angiography (CTCA) can discriminate between type 1 and type 2 myocardial infarction.
Materials And Methods:
This was a secondary analysis of two prospective studies (ClinicalTrials.gov registration nos. NCT03338504 [2014-2019] and NCT02284191 [2018-2020]) that performed blinded quantitative plaque analysis on findings from CTCA in participants with type 1 myocardial infarction, type 2 myocardial infarction, and chest pain without myocardial infarction. Logistic regression analyses were performed to identify predictors of type 1 myocardial infarction.
Results:
Overall, 155 participants (mean age, 64 years ± 12 [SD]; 114 men) and 36 participants (mean age, 67 years ± 12; 19 men) had type 1 and type 2 myocardial infarction, respectively, and 136 participants (62 years ± 12; 78 men) had chest pain without myocardial infarction. Participants with type 1 myocardial infarction had greater total (median, 44% [IQR: 35%-50%] vs 35% [IQR: 29%-46%]), noncalcified (39% [IQR: 31%-46%] vs 34% [IQR: 29%-40%]), and low-attenuation (4.15% [IQR: 1.88%-5.79%] vs 1.64% [IQR: 0.89%-2.28%]) plaque burdens (P < .05 for all) than those with type 2. Participants with type 2 myocardial infarction had similar low-attenuation plaque burden to those with chest pain without myocardial infarction (P = .4). Low-attenuation plaque was an independent predictor of type 1 myocardial infarction (adjusted odds ratio, 3.44 [95% CI: 1.84, 6.96]; P < .001), with better discrimination than noncalcified plaque burden and maximal area of coronary stenosis (C statistic, 0.75 [95% CI: 0.67, 0.83] vs 0.62 [95% CI: 0.53, 0.71] and 0.61 [95% CI: 0.51, 0.70] respectively; P ≤ .001 for both).
Conclusion:
Higher low-attenuation coronary plaque burden in patients with type 1 myocardial infarction may help distinguish these patients from those with type 2 myocardial infarction.Keywords: Ischemia/Infarction, CT Angiography, Quantitative CTClinical trial registration nos. NCT03338504 and NCT02284191 Supplemental material is available for this article. © RSNA, 2022.
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