Author + information
- James A. Goldstein, MD, FACC⁎,
- Simon Dixon, MBChB,
- Robert D. Safian, MD, FACC,
- George Hanzel, MD, FACC,
- Cindy L. Grines, MD, FACC and
- Gilbert L. Raff, MD, FACC
James A. Goldstein, MD, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, Michigan 48073.
complex plaque morphology is the angiographic hallmark of unstable coronary lesions. Invasively, complex lesions are characterized by haziness, irregularity, frank ulceration, intraplaque contrast persistence, and luminal filling defect. Computed tomographic coronary angiography (CTA) features of plaques in patients with acute coronary syndromes (ACS) are just being identified. However, the CTA correlates of angiographically diagnosed, complex unstable coronary lesions have not been fully delineated. We present a collage of representative images (rogues gallery) to identify CTA correlates of invasively proven, complex unstable plaques in a cohort of 49 patients presenting with ACS and/or chest pain. The CTA-documented lesion morphology was strikingly similar to invasive angiographic features indicative of plaque disruption, including lesion haziness (55%), irregularity (55%), ulceration (67%), and intraplaque contrast penetration (62%). On CTA images, complex lesions typically appeared bulky, hypodense, eccentric (index = 0.33 ± 0.29), and positively remodeled (index = 1.5 ± 0.77) (Figs. 1 to 7),⇓⇓⇓⇓⇓⇓ with features similar to complex ruptured plaque seen by intravascular ultrasound (Figs. 1, 2, and 7). Given the increasing use of CTA to evaluate acute chest pain, characterization of plaque instability has considerable clinical implications. Further studies will be necessary to establish the sensitivity, specificity, and predictive accuracy of CTA for characterization of complex plaque.
Supported in part by a grant from the Ministrelli Advanced Cardiac Research Imaging Center, Royal Oak, Michigan.
- American College of Cardiology Foundation