Plaque Characteristics of Consecutive 31 Cases Which Cause Acute Myocardial Infarction on Coronary Computed Tomography Angiography  [in Japanese]

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Abstract

<b>Background:</b>It has been reported that various types of vulnerable plaque can cause acute myocardial infarction (AMI). The diagnosis of vulnerable plaques using coronary computed tomography angiography (CCTA) has not been established. We evaluated the plaque characteristics on CCTA in subjects who developed AMI more than 30 days after the CCTA was performed. <b>Methods and Results:</b> The subjects were 31 consecutive patients (M/F=29/2, 67±10 yrs, period to AMI onset, 559±490 days, known CAD: 16) who developed AMI more than 30 days after the CCTA examination. Culprit lesions were observed in the LMT in 2 patients, RCA in 11, LAD in 12 and LCX in 6. No significant stenosis (≤50%) could be found in 24 (77.4%) patients. Positive remodeling (PR: remodeling index >1.1) was found in 24 (77.4%) patients and low-density plaque (LDP: CT values ≤50 HU) was found in 17 (54.8%). Calcification was spotty in 9 patients, moderate in 12, severe in 4 and absent in 6. The period to AMI onset tended to be shorter in patients with ≥75% stenosis, and the patients in the PR(+) group were significantly younger. Vulnerable plaques identified by CCTA were classified into 4 types: Type I (PR(+) and LDP(+)) in 17 (54.8%) patients, Type II (PR(+) and LDP(−)) in 7 (22.6%), Type III (PR(−) and LDP(−)) in 4 (12.9%), and Type IV (PR(−) and severe calcification) in 3 (9.7%). <b>Conclusions:</b> AMI arose from plaques with various manifestations on CCTA, but as many as about half of the AMI events were derived from Type I (PR(+) and LDP(+)) plaques in younger patients.

Journal

  • Journal of the Japanese Coronary Association

    Journal of the Japanese Coronary Association, 2015

    The Japanese Coronary Association

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