Natural history of coronary atherosclerosis by multislice computed tomography

JACC Cardiovasc Imaging. 2012 Mar;5(3 Suppl):S28-37. doi: 10.1016/j.jcmg.2012.01.009.

Abstract

Objectives: This study sought to analyze the natural history of coronary atherosclerosis by multislice computed tomography (MSCT) and assess the serial changes in coronary plaque burden, lumen dimensions, and arterial remodeling.

Background: MSCT can comprehensively assess coronary atherosclerosis by combining lumen and plaque size parameters.

Methods: Thirty-two patients with acute coronary syndromes underwent 64-slice computed tomography angiography after percutaneous coronary intervention at baseline and after a median of 39 months. All patients received contemporary medical treatment. All available coronary segments in every subject were analyzed. The progression of atherosclerosis per segment and per patient was assessed by means of change in percent atheroma volume (PAV), change in normalized total atheroma volume (TAVnorm), and percent change in TAV (% change in TAV). Serial coronary remodeling was also assessed. Measures of lumen stenosis included percent diameter stenosis (%DS), minimum lumen diameter (MLD), percent area stenosis (%AS), and minimum lumen area (MLA). For each patient, the mean of all matched segments was calculated at the 2 time points. Clinical events at follow-up were documented.

Results: The PAV did not change significantly (-0.15 ± 3.64%, p = 0.72). The mean change in TAVnorm was 47.36 ± 143.24 mm(3) (p = 0.071), and the % change in TAV was 6.7% (p = 0.029). The MLD and MLA increased by 0.15 mm (-0.09 to 0.24, p = 0.039) and 0.52 mm(2) (-0.38 to 1.04, p = 0.034) respectively, which was accompanied by vessel enlargement, with 53% of the patients showing expansive positive remodeling. Patients with clinical events had a larger TAVnorm at baseline (969.72 mm(3) vs. 810.77 mm(3), p = 0.010).

Conclusions: MSCT can assess the progression of coronary atherosclerosis and may be used for noninvasive monitoring of pharmacological interventions in coronary artery disease. (

Prospect: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466).

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Angioplasty, Balloon, Coronary / adverse effects
  • Coronary Angiography / methods*
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / therapy
  • Coronary Stenosis / diagnostic imaging*
  • Coronary Stenosis / epidemiology
  • Coronary Stenosis / therapy
  • Disease Progression
  • Europe / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Plaque, Atherosclerotic / diagnostic imaging*
  • Plaque, Atherosclerotic / epidemiology
  • Plaque, Atherosclerotic / therapy
  • Predictive Value of Tests
  • Prospective Studies
  • Reproducibility of Results
  • Severity of Illness Index
  • Time Factors
  • Tomography, X-Ray Computed*
  • Treatment Outcome
  • Ultrasonography, Interventional
  • United States / epidemiology
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / epidemiology

Associated data

  • ClinicalTrials.gov/NCT00180466