Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome

Daniel O. Bittner, Thomas Mayrhofer, Stefan B. Puchner, Michael T. Lu, Pal Maurovich-Horvat, Khristine Ghemigian, Pieter H. Kitslaar, Alexander Broersen, Fabian Bamberg, Quynh A. Truong, Christopher L. Schlett, Udo Hoffmann, Maros Ferencik

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background High-risk plaque (HRP) features as detected by coronary computed tomography angiography (CTA) predict acute coronary syndrome (ACS). We sought to determine whether coronary CTA-specific definitions of HRP improve discrimination of patients with ACS as compared with definitions from intravascular ultrasound (IVUS). Methods and Results In patients with suspected ACS, randomized to coronary CTA in the ROMICAT II (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography II) trial, we retrospectively performed semiautomated quantitative analysis of HRP (including remodeling index, plaque burden as derived by plaque area, low computed tomography attenuation plaque volume) and degree of luminal stenosis and analyzed the performance of traditional IVUS thresholds to detect ACS. Furthermore, we derived CTA-specific thresholds in patients with ACS to detect culprit lesions and applied those to all patients to calculate the discriminatory ability to detect ACS in comparison to IVUS thresholds. Of 472 patients, 255 patients (56±7.8 years; 63% men) had coronary plaque. In 32 patients (6.8%) with ACS, culprit plaques (n=35) differed from nonculprit plaques (n=172) with significantly greater values for all HRP features except minimal luminal area (significantly lower; all P<0.01). IVUS definitions showed good performance while minimal luminal area (odds ratio: 6.82; P=0.014) and plaque burden (odds ratio: 5.71; P=0.008) were independently associated with ACS but not remodeling index (odds ratio: 0.78; P=0.673). Optimized CTA-specific thresholds for plaque burden (area under the curve: 0.832 versus 0.676) and degree of stenosis (area under the curve: 0.826 versus 0.721) showed significantly higher diagnostic performance for ACS as compared with IVUS-based thresholds (all P<0.05) with borderline significance for minimal luminal area (area under the curve: 0.817 versus 0.742; P=0.066). Conclusions CTA-specific definitions of HRP features may improve the discrimination of patients with ACS as compared with IVUS-based definitions. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01084239.

Original languageEnglish (US)
Pages (from-to)e007657
JournalCirculation. Cardiovascular imaging
Volume11
Issue number8
DOIs
StatePublished - Aug 1 2018
Externally publishedYes

Fingerprint

Acute Coronary Syndrome
Area Under Curve
Odds Ratio
Pathologic Constriction
Tomography
Computed Tomography Angiography
Myocardial Ischemia
Myocardial Infarction
Clinical Trials

Keywords

  • acute coronary syndrome
  • angiography
  • computed tomography angiography
  • coronary angiography
  • myocardial ischemia
  • tomography, X-ray computed
  • ultrasonography, intravascular

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome. / Bittner, Daniel O.; Mayrhofer, Thomas; Puchner, Stefan B.; Lu, Michael T.; Maurovich-Horvat, Pal; Ghemigian, Khristine; Kitslaar, Pieter H.; Broersen, Alexander; Bamberg, Fabian; Truong, Quynh A.; Schlett, Christopher L.; Hoffmann, Udo; Ferencik, Maros.

In: Circulation. Cardiovascular imaging, Vol. 11, No. 8, 01.08.2018, p. e007657.

Research output: Contribution to journalArticle

Bittner, DO, Mayrhofer, T, Puchner, SB, Lu, MT, Maurovich-Horvat, P, Ghemigian, K, Kitslaar, PH, Broersen, A, Bamberg, F, Truong, QA, Schlett, CL, Hoffmann, U & Ferencik, M 2018, 'Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome', Circulation. Cardiovascular imaging, vol. 11, no. 8, pp. e007657. https://doi.org/10.1161/CIRCIMAGING.118.007657
Bittner, Daniel O. ; Mayrhofer, Thomas ; Puchner, Stefan B. ; Lu, Michael T. ; Maurovich-Horvat, Pal ; Ghemigian, Khristine ; Kitslaar, Pieter H. ; Broersen, Alexander ; Bamberg, Fabian ; Truong, Quynh A. ; Schlett, Christopher L. ; Hoffmann, Udo ; Ferencik, Maros. / Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome. In: Circulation. Cardiovascular imaging. 2018 ; Vol. 11, No. 8. pp. e007657.
@article{cd4bca527ae34bce9f21b310c8125748,
title = "Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome",
abstract = "Background High-risk plaque (HRP) features as detected by coronary computed tomography angiography (CTA) predict acute coronary syndrome (ACS). We sought to determine whether coronary CTA-specific definitions of HRP improve discrimination of patients with ACS as compared with definitions from intravascular ultrasound (IVUS). Methods and Results In patients with suspected ACS, randomized to coronary CTA in the ROMICAT II (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography II) trial, we retrospectively performed semiautomated quantitative analysis of HRP (including remodeling index, plaque burden as derived by plaque area, low computed tomography attenuation plaque volume) and degree of luminal stenosis and analyzed the performance of traditional IVUS thresholds to detect ACS. Furthermore, we derived CTA-specific thresholds in patients with ACS to detect culprit lesions and applied those to all patients to calculate the discriminatory ability to detect ACS in comparison to IVUS thresholds. Of 472 patients, 255 patients (56±7.8 years; 63{\%} men) had coronary plaque. In 32 patients (6.8{\%}) with ACS, culprit plaques (n=35) differed from nonculprit plaques (n=172) with significantly greater values for all HRP features except minimal luminal area (significantly lower; all P<0.01). IVUS definitions showed good performance while minimal luminal area (odds ratio: 6.82; P=0.014) and plaque burden (odds ratio: 5.71; P=0.008) were independently associated with ACS but not remodeling index (odds ratio: 0.78; P=0.673). Optimized CTA-specific thresholds for plaque burden (area under the curve: 0.832 versus 0.676) and degree of stenosis (area under the curve: 0.826 versus 0.721) showed significantly higher diagnostic performance for ACS as compared with IVUS-based thresholds (all P<0.05) with borderline significance for minimal luminal area (area under the curve: 0.817 versus 0.742; P=0.066). Conclusions CTA-specific definitions of HRP features may improve the discrimination of patients with ACS as compared with IVUS-based definitions. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01084239.",
keywords = "acute coronary syndrome, angiography, computed tomography angiography, coronary angiography, myocardial ischemia, tomography, X-ray computed, ultrasonography, intravascular",
author = "Bittner, {Daniel O.} and Thomas Mayrhofer and Puchner, {Stefan B.} and Lu, {Michael T.} and Pal Maurovich-Horvat and Khristine Ghemigian and Kitslaar, {Pieter H.} and Alexander Broersen and Fabian Bamberg and Truong, {Quynh A.} and Schlett, {Christopher L.} and Udo Hoffmann and Maros Ferencik",
year = "2018",
month = "8",
day = "1",
doi = "10.1161/CIRCIMAGING.118.007657",
language = "English (US)",
volume = "11",
pages = "e007657",
journal = "Circulation. Cardiovascular imaging",
issn = "1941-9651",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Coronary Computed Tomography Angiography-Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome

AU - Bittner, Daniel O.

AU - Mayrhofer, Thomas

AU - Puchner, Stefan B.

AU - Lu, Michael T.

AU - Maurovich-Horvat, Pal

AU - Ghemigian, Khristine

AU - Kitslaar, Pieter H.

AU - Broersen, Alexander

AU - Bamberg, Fabian

AU - Truong, Quynh A.

AU - Schlett, Christopher L.

AU - Hoffmann, Udo

AU - Ferencik, Maros

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background High-risk plaque (HRP) features as detected by coronary computed tomography angiography (CTA) predict acute coronary syndrome (ACS). We sought to determine whether coronary CTA-specific definitions of HRP improve discrimination of patients with ACS as compared with definitions from intravascular ultrasound (IVUS). Methods and Results In patients with suspected ACS, randomized to coronary CTA in the ROMICAT II (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography II) trial, we retrospectively performed semiautomated quantitative analysis of HRP (including remodeling index, plaque burden as derived by plaque area, low computed tomography attenuation plaque volume) and degree of luminal stenosis and analyzed the performance of traditional IVUS thresholds to detect ACS. Furthermore, we derived CTA-specific thresholds in patients with ACS to detect culprit lesions and applied those to all patients to calculate the discriminatory ability to detect ACS in comparison to IVUS thresholds. Of 472 patients, 255 patients (56±7.8 years; 63% men) had coronary plaque. In 32 patients (6.8%) with ACS, culprit plaques (n=35) differed from nonculprit plaques (n=172) with significantly greater values for all HRP features except minimal luminal area (significantly lower; all P<0.01). IVUS definitions showed good performance while minimal luminal area (odds ratio: 6.82; P=0.014) and plaque burden (odds ratio: 5.71; P=0.008) were independently associated with ACS but not remodeling index (odds ratio: 0.78; P=0.673). Optimized CTA-specific thresholds for plaque burden (area under the curve: 0.832 versus 0.676) and degree of stenosis (area under the curve: 0.826 versus 0.721) showed significantly higher diagnostic performance for ACS as compared with IVUS-based thresholds (all P<0.05) with borderline significance for minimal luminal area (area under the curve: 0.817 versus 0.742; P=0.066). Conclusions CTA-specific definitions of HRP features may improve the discrimination of patients with ACS as compared with IVUS-based definitions. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01084239.

AB - Background High-risk plaque (HRP) features as detected by coronary computed tomography angiography (CTA) predict acute coronary syndrome (ACS). We sought to determine whether coronary CTA-specific definitions of HRP improve discrimination of patients with ACS as compared with definitions from intravascular ultrasound (IVUS). Methods and Results In patients with suspected ACS, randomized to coronary CTA in the ROMICAT II (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography II) trial, we retrospectively performed semiautomated quantitative analysis of HRP (including remodeling index, plaque burden as derived by plaque area, low computed tomography attenuation plaque volume) and degree of luminal stenosis and analyzed the performance of traditional IVUS thresholds to detect ACS. Furthermore, we derived CTA-specific thresholds in patients with ACS to detect culprit lesions and applied those to all patients to calculate the discriminatory ability to detect ACS in comparison to IVUS thresholds. Of 472 patients, 255 patients (56±7.8 years; 63% men) had coronary plaque. In 32 patients (6.8%) with ACS, culprit plaques (n=35) differed from nonculprit plaques (n=172) with significantly greater values for all HRP features except minimal luminal area (significantly lower; all P<0.01). IVUS definitions showed good performance while minimal luminal area (odds ratio: 6.82; P=0.014) and plaque burden (odds ratio: 5.71; P=0.008) were independently associated with ACS but not remodeling index (odds ratio: 0.78; P=0.673). Optimized CTA-specific thresholds for plaque burden (area under the curve: 0.832 versus 0.676) and degree of stenosis (area under the curve: 0.826 versus 0.721) showed significantly higher diagnostic performance for ACS as compared with IVUS-based thresholds (all P<0.05) with borderline significance for minimal luminal area (area under the curve: 0.817 versus 0.742; P=0.066). Conclusions CTA-specific definitions of HRP features may improve the discrimination of patients with ACS as compared with IVUS-based definitions. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01084239.

KW - acute coronary syndrome

KW - angiography

KW - computed tomography angiography

KW - coronary angiography

KW - myocardial ischemia

KW - tomography, X-ray computed

KW - ultrasonography, intravascular

UR - http://www.scopus.com/inward/record.url?scp=85055605686&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055605686&partnerID=8YFLogxK

U2 - 10.1161/CIRCIMAGING.118.007657

DO - 10.1161/CIRCIMAGING.118.007657

M3 - Article

VL - 11

SP - e007657

JO - Circulation. Cardiovascular imaging

JF - Circulation. Cardiovascular imaging

SN - 1941-9651

IS - 8

ER -