Assessing culprit lesions and active complex lesions in patients with early acute myocardial infarction by multidetector computed tomography.
BACKGROUND
Accurate, non-invasive characterization of culprit lesions in patients after acute myocardial infarction (AMI) remains challenging. In this prospective study, multidetector row computed tomography (MDCT) is used to assess culprit and active complex lesions in patients early after AMI.


RESULTS
We enrolled 103 patients with first non ST-elevation AMI who underwent 64-slices MDCT and conventional coronary angiography (CCAG). The definition of culprit lesion, stable non-culprit lesions and non-culprit active complex lesions was based on the findings of CCAG. The lesions were analyzed with MDCT data. In culprit lesions (n=103), luminal artery stenosis, remodeling index, plaque area and burden were significantly higher than non-culprit lesions (n=129). Multivariate discriminant analysis showed that MDCT density could discriminate culprit from non-culprit lesions. Receiver-operator characteristic curve analysis identified the optimal cutoff value of lesion density for discrimination between culprit and non-culprit lesion as 49.6 Hounsfield units (HU); this value was associated with a sensitivity, specificity and accuracy of 88.4%, 87.4%, and 87.9%, respectively. The MDCT in the stable non-culprit lesions (81.8+/-15.5 HU) was significantly higher than that in culprit lesions or non-culprit active complex lesions (33.2+/-13.8 and 48.3+/-15.7 HU, p<0.001).


CONCLUSIONS
MDCT can predict culprit lesions in patients early after AMI, and identify multiple complex lesions.
Huang
Wei-Chun
WC
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
Wu
Ming-Ting
MT
Chiou
Kuan-Rau
KR
Mar
Guang-Yuan
GY
Hsiao
Shih-Hung
SH
Lin
Shih-Kai
SK
Yeh
Tung-Cheng
TC
Huang
Yi-Luan
YL
Hsiao
Hsiang-Chiang
HC
Lee
Doyal
D
Chiou
Chuen-Wang
CW
Lin
Shoa-Lin
SL
Liu
Chun-Peng
CP
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed