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Coronary Inflammation and Plaque Vulnerability: A Coronary Computed Tomography and Optical Coherence Tomography Study
Haruhito Yuki1, Tomoyo Sugiyama2, Keishi Suzuki1
1Cardiology Division (H.Y., K.S., D.K., T.N., I.M., I.-K.J.), Massachusetts General Hospital, Harvard Medical School, Boston.
Insights
High peri-coronary adipose tissue (PCAT) attenuation indicates increased vascular inflammation. This inflammation is closely linked to vulnerable coronary artery plaque characteristics, suggesting a connection between inflammation and plaque instability in coronary artery disease.
Area of Science:
- Cardiology
- Radiology
- Pathology
Background:
- Vascular inflammation is central to atherosclerosis and acute coronary syndromes.
- Peri-coronary adipose tissue (PCAT) attenuation on CT angiography quantifies coronary inflammation.
- This study investigates the link between PCAT attenuation and coronary plaque characteristics.
Purpose of the Study:
- To examine the relationship between coronary artery inflammation, assessed by PCAT attenuation, and coronary plaque characteristics.
- To compare plaque vulnerability features in patients with high versus low PCAT attenuation.
Main Methods:
- 474 patients (acute coronary syndromes and stable angina) with CT angiography and optical coherence tomography data were analyzed.
- Patients were stratified into high (n=244) and low (n=230) PCAT attenuation groups using a -70.1 HU threshold.
- Coronary plaque characteristics were assessed using optical coherence tomography.
Main Results:
- High PCAT attenuation was associated with more males, non-ST-segment elevation myocardial infarction, and less stable angina.
- Patients with high PCAT attenuation had lower ejection fraction and HDL cholesterol levels.
- Vulnerable plaque features like lipid-rich plaque, macrophage infiltration, microchannels, plaque rupture, and layered plaque were more prevalent in the high PCAT attenuation group.
Conclusions:
- High PCAT attenuation is significantly associated with increased coronary artery inflammation.
- Features of plaque vulnerability are more common in patients with high PCAT attenuation.
- Vascular inflammation and plaque vulnerability are closely interrelated in coronary artery disease.
Background:
Vascular inflammation plays a key role in atherogenesis and in the development of acute coronary syndromes. Coronary inflammation can be measured by peri-coronary adipose tissue (PCAT) attenuation on computed tomography angiography. We examined the relationships between the level of coronary artery inflammation assessed by PCAT attenuation and coronary plaque characteristics by optical coherence tomography.
Methods:
A total of 474 patients (198 acute coronary syndromes and 276 stable angina pectoris) who underwent preintervention coronary computed tomography angiography and optical coherence tomography were included. To compare the relationships between the level of coronary artery inflammation and detailed plaque characteristics, we divided the subjects into high (n=244) and low (n=230) PCAT attenuation groups using a threshold value of -70.1 Hounsfield units.
Results:
The high PCAT attenuation group, compared with the low PCAT attenuation group, had more males (90.6% versus 69.6%; P<0.001), more non-ST-segment elevation myocardial infarction (38.5% versus 25.7%; P=0.003), and less stable angina pectoris (51.6% versus 65.2%; P=0.003). Aspirin, dual antiplatelet, and statins were less frequently used in the high PCAT attenuation group compared to the low PCAT attenuation group. Patients with high PCAT attenuation, compared with those with low PCAT attenuation, had lower ejection fraction (median 64% versus 65%; P=0.014) and lower levels of high-density lipoprotein cholesterol (median 45 versus 48 mg/dL; P=0.027). Optical coherence tomography features of plaque vulnerability were significantly more common in patients with high PCAT attenuation, compared to those with low PCAT attenuation, including lipid-rich plaque (87.3% versus 77.8%; P=0.006), macrophage (76.2% versus 67.8%; P=0.041), microchannels (61.9% versus 48.3%; P=0.003), plaque rupture (38.1% versus 23.9%; P<0.001), and layered plaque (60.2% versus 50.0%; P=0.025).
Conclusions:
Optical coherence tomography features of plaque vulnerability were significantly more common in patients with high PCAT attenuation, compared with those with low PCAT attenuation. Vascular inflammation and plaque vulnerability are intimately related in patients with coronary artery disease.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifier: NCT04523194.
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