title: Assessing culprit lesions and active complex lesions in patients with early acute myocardial infarction by multidetector computed tomography.
abstract: 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.
authors.affiliation: Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Huang
authors.forename: Ming-Ting
authors.initials: MT
authors.lastname: Wu
authors.forename: Kuan-Rau
authors.initials: KR
authors.lastname: Chiou
authors.forename: Guang-Yuan
authors.initials: GY
authors.lastname: Mar
authors.forename: Shih-Hung
authors.initials: SH
authors.lastname: Hsiao
authors.forename: Shih-Kai
authors.initials: SK
authors.lastname: Lin
authors.forename: Tung-Cheng
authors.initials: TC
authors.lastname: Yeh
authors.forename: Yi-Luan
authors.initials: YL
authors.lastname: Huang
authors.forename: Hsiang-Chiang
authors.initials: HC
authors.lastname: Hsiao
authors.forename: Doyal
authors.initials: D
authors.lastname: Lee
authors.forename: Chuen-Wang
authors.initials: CW
authors.lastname: Chiou
authors.forename: Shoa-Lin
authors.initials: SL
authors.lastname: Lin
authors.forename: Chun-Peng
authors.initials: CP
authors.lastname: Liu
mesh_terms: 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