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Coronary computed tomography angiography with a diluted contrast material method demonstrates associations between coronary plaque characteristics and periprocedural MI in patients with stable angina

Session Poster session 1

Speaker Tatsuya Shigematsu

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : T Shigematsu (Matsuyama,JP), H Okayama (Matsuyama,JP), N Kawaguchi (Matsuyama,JP), K Matsuda (Matsuyama,JP), T Yamamoto (Matsuyama,JP), T Kosaki (Matsuyama,JP), S Hosokawa (Matsuyama,JP), G Kawamura (Matsuyama,JP), T Takahashi (Matsuyama,JP), M Kinoshita (Matsuyama,JP), Y Kawata (Matsuyama,JP), G Hiasa (Matsuyama,JP), T Yamada (Matsuyama,JP), Y Kazatani (Matsuyama,JP)

T. Shigematsu1 , H. Okayama1 , N. Kawaguchi1 , K. Matsuda1 , T. Yamamoto1 , T. Kosaki1 , S. Hosokawa1 , G. Kawamura1 , T. Takahashi1 , M. Kinoshita1 , Y. Kawata1 , G. Hiasa1 , T. Yamada1 , Y. Kazatani1 , 1Ehime Prefectural Central Hospital - Matsuyama - Japan ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 185

Background: Target lesion characteristics are associated with periprocedural myocardial infarction (PMI) after elective percutaneous coronary intervention (PCI). However, attenuation in coronary computed tomography angiography (CCTA) can affect qualitative plaque assessments. Recently, we demonstrated a novel scan procedure with a personalized contrast injection protocol (the diluted contrast material method [DCMM]). This method results in more uniform attenuation during CCTA and allows the evaluation of quantitative and qualitative parameters.

Purpose: We aimed to clarify the association between PMI and plaque characteristics using CCTA with DCMM.

Methods: Patients with stable angina (n=80) and normal levels of high-sensitivity cardiac troponin I (hsTnI) underwent 256-slice multidetector CCTA with DCMM before elective PCI. hsTnI levels were examined 18 h after PCI; PMI was defined as a level of more than 5 times the upper reference limit. Low attenuation plaque (LAP; CT attenuation <30 HU) and positive remodeling (PR; remodeling index [RI] >1.05) were assessed in patients with PMI (Group I, n=33, 41.2%) and without PMI (Group II, n=47, 58.8%). To evaluate the optimization of the coronary attenuation in CCTA with DCMM, all patients underwent attenuation assessment for the aorta, origin of the left main trunk (LMT), and the proximal portions of the left anterior descending coronary artery (pLAD), left circumflex artery (pLCX), and right coronary artery (pRCA).

Results: The mean aortic and coronary attenuations (all segments) were 378.0±44.5 HU and 369.5±49.8 HU, respectively. Attenuation for each segment was as follows: LMT, 369.8±59.8 HU; pLAD, 371.6±59.8 HU; pLCX, 374.1±61.0 HU; and pRCA, 374.1±67.1 HU. RI was significantly greater in Group I compared to that in Group II (1.18±0.17 vs. 0.97±0.15; P<0.05). CT attenuation was significantly lower in Group I compared to that in Group II (37.1±26.4 HU vs. 79.8±63.8 HU, P<0.05). The incidence of LAP and PR was significantly higher in Group I compared to those in Group II (LAP, 66.6% vs. 19.1%; PR, 78.8% vs. 25.5%; P's <0.05). Furthermore, LAP and PR were significant independent predictors of PMI (LAP: odds ratio, 5.03; 95% confidence interval, P=0.05; PR: odds ratio, 7.08; 95% confidence interval, P=0.01).

Conclusions: Using multidetector CCTA with DCMM, which has improved attenuation uniformity, LAP and PR were found to be significant predictors of PMI.

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