European Heart Journal Advance Access published online on August 5, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn356
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Evaluation of plaque characteristics in acute coronary syndromes: non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis
1 Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
2 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
3 Department of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania
4 Cardiovascular Center, OLV Hospital, Aalst, Belgium
5 Department of Epidemiology and Statistics, Erasmus University, Rotterdam, The Netherlands
Received 26 July 2007; revised 14 July 2008; accepted 17 July 2008.
* Corresponding author. Tel: +31 71 5262020, Fax: +31 71 5266809, Email: j.j.bax{at}lumc.nl
Aims: Atherosclerotic plaque characteristics play an important role in the development of coronary events. We investigated coronary plaque characteristics on multi-slice computed tomography (MSCT) and virtual histology intravascular ultrasound (VH IVUS) in patients with acute coronary syndromes (ACS) and stable coronary artery disease (CAD).
Methods and results: Fifty patients (25 with ACS, 25 with stable CAD) underwent 64-slice MSCT followed by VH IVUS in 48 (96%) patients. In ACS patients, 32% of plaques were non-calcified on MSCT and 59% were mixed [corresponding odds ratio (95% confidence intervals): 3.9 (1.6–9.5), P = 0.003 and 3.4 (1.6–6.9), P = 0.001, respectively]. In patients with stable CAD, completely calcified lesions were more prevalent (61%). On VH IVUS, the percentage of necrotic core was higher in the plaques of ACS patients (11.16 ± 6.07 vs. 9.08 ± 4.62% in stable CAD, P = 0.02). In addition, thin cap fibroatheroma was more prevalent in ACS patients (32 vs. 3% in patients with stable CAD, P < 0.001) and was most frequently observed in mixed plaques on MSCT. Plaque composition both on MSCT and VH IVUS was identical between culprit and non-culprit vessels of ACS patients.
Conclusion: On MSCT, differences in plaque characterization were demonstrated between patients with ACS and stable CAD. Plaques of ACS patients showed features of vulnerability to rupture on VH IVUS. Potentially, MSCT may be useful for non-invasive identification of atherosclerotic plaque patterns associated with higher risk.
Key Words: Atherosclerosis • Coronary artery disease • Acute coronary syndromes • Multi-slice CT • Intravascular ultrasound
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