title: Characteristics of coronary plaques before angiographic progression determined by Multi-Slice CT.
abstract: The aim of the present study was to characterize coronary plaques by Multi-Slice Computed Tomography (Siemens sensation 16, Forcheim, Germany) before significant angiographic progression occurred and to compare them to non-progressing lesions. The MSCT-morphology of coronary plaques leading to a rapid angiographic disease progression is not yet studied. In a series of 68 patients who were scheduled for surveillance angiography 6 months later, MSCT-angiography was done shortly after the baseline catheterisation-procedure. After surveillance angiography rapid progressive lesions with an increase of the stenosis severity of >20% were identified and analysed on the baseline MSCT-scan and were compared to non-progressing lesions. Six months after coronary stenting we observed significant progression of de novo stenoses in 10/438 coronary segments. The progression of four lesions lead to angina pectoris symptoms and the remaining six lesions progressed silently. Analysis of the lesion morphology by MSCT revealed that 5/10 (50%) progressing lesions were non-calcified 3/10 (30%) were predominantly non-calcified and 2/10 (20%) were mainly calcified on the baseline MSCT-scan. In the 428 segments without disease progression atherosclerotic lesions were found in 225 segments on MSCT. Non-calcified plaques were identified in 46 (20%), predominantly non-calcified lesions in 58 (26%) and predominantly calcified lesions in 121 (54%) segments. The average number of diseased coronary segments between patients with and without lesion progression was not significantly different between progressors and non-progressors with a higher prevalence of non-calcified segments in the progressor group (1.1 vs. 0.63). Rapid progression of the angiographic stenosis severity during a 6 months period occurs most frequently in coronary segments revealing non-calcified or predominantly non-calcified plaques as determined by MSCT, whereas lesion progression is rare in predominantly calcified segments. This represents first evidence that non-calcified lesions may be involved in the process of plaque rupture.
authors.affiliation: Medizinische Klinik I, Klinikum Grosshadern, Department of Cardiology, Ludwig Maximilians University of Munich, Marchioninistrasse 15, 81377, Munich, Germany. aleber@helios.med.uni-muenchen.de
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Leber
authors.forename: Franz
authors.initials: F
authors.lastname: von Ziegler
authors.forename: Alexander
authors.initials: A
authors.lastname: Becker
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Becker
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.forename: Gerhard
authors.initials: G
authors.lastname: Steinbeck
authors.forename: Andreas
authors.initials: A
authors.lastname: Knez
authors.forename: Peter
authors.initials: P
authors.lastname: Boekstegers
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012107:Research Design; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome