Ming-Ting Wu MD, Presenter: Nothing to Disclose

Yi-Luan Huang MD, Abstract Co-Author: Nothing to Disclose

fu-zong wu, Abstract Co-Author: Nothing to Disclose

Chen-Wen Yen, Abstract Co-Author: Nothing to Disclose

Huey-Shyan Lin PhD, Abstract Co-Author: Nothing to Disclose

Carol C. Wu MD, Abstract Co-Author: Author, Reed Elsevier

Many patients with acute coronary syndrome (ACS) have low Agatston score (AS). Recent study showed lower density score of coronary artery calcification (CAC) plaque tended to have higher risk of ACS. We aimed to evaluate the characteristic of plaque attenuation features of CAC in three groups: asymptomatic, stable angina pectorals (SAP) and ASC.

We retrospectively reviewed 159 symptomatic patients and 365 asymptomatic subjects receiving non-contrast cardiac CT in a period of 18 months; After excluding those without CAC or post intervention, 298 subjects, including ACS=41, SAP=78 and asymptomatic=159, were enrolled for analysis of CAC plaque features. Subject analysis included AS and number of plaques (NP). Plaque analysis included mean (HMEAN) and standard deviation (HSD) of attenuation per plaque. Median [min,-max] was used for express and statistics.

Comparison of subject analysis showed the SAP group had significant higher AS (237 [1.2-2143]) and NP (9 [1-31]) than that of asymptomatic group (AS=54 [1.8-1725]; NP=3 [1-38], both P<.001), while no difference between SAP and ACS group (AS=112 [2.3-3447], NP=8 [2-36])(P>.5). Plaque analysis showed ACS had significant lower and homogenous attenuation (HMEAN =180 [147-268], HSD=31 [9.9-121]) than that of SAP (HMEAN= 204 [140-343], HSD=54 [4.7-183], P = .016, .011, respectively) and that of asymptomatic (HMEAN=205 [142-359], HSD=52 [8.4-208]; P=.002, .006, respectively). While no difference between SAP and asymptomatic groups (both P>.5). ROC curves showed adding the AS on model of conventional risk factors did not improved AUC (from 0.79 to 0.83, P=0.21) in discriminating ACS from asymptomatic group; while adding plaque analysis on model of conventional risk factor plus AS significantly improved the AUC from 0.83 to 0.93 (P=.003).

In addition to lower HMEAN, smaller HSD was also a important attenuation feature of CAC plaque in ACS in this cross sectional study. With validation of a large cohort study, these plaque feature may serve as a novel biomarker to improve ACS risk stratification.

Attenuation feature analysis of CAC plaque in addition AS can enhance the risk stratification of coronary artery disease by non-contrast cardiac CT

Wu, M, Huang, Y, wu, f, Yen, C, Lin, H, Wu, C, CT Attenuation Feature Analysis Characterizes the Coronary Calcified Plaque in Acute Coronary Syndrome.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008956.html