title: Coronary atherosclerosis in African American and white patients with acute chest pain: characterization with coronary CT angiography.
abstract: OBJECTIVE
  To use coronary computed tomographic (CT) angiography to compare the prevalence, extent, and composition of coronary atherosclerotic lesions in African American and white patients with acute chest pain.
  
  
  METHODS
  The institutional review board waived the requirement for informed consent for this retrospective, HIPAA-compliant matched-cohort study. The authors analyzed the CT angiographic data of 301 patients (150 consecutive African American patients; 151 white control patients; mean age, 55 years ± 11 [standard deviation]; 33% male) with acute chest pain. Each coronary artery segment was evaluated for presence of atherosclerotic plaque, plaque composition (calcified, noncalcified, or mixed), and stenosis. In addition, the noncalcified plaque volume was quantified by using a threshold-based automated algorithm. The presence and extent of atherosclerotic plaque were compared between the groups by using univariate and multivariate regression analyses.
  
  
  RESULTS
  While there was no significant difference between the African American and white patients with respect to presence of any plaque (118 [79%] of 150 vs 112 [74%] of 151 patients, respectively; P = .36) or presence of stenosis (26 [17%] vs 37 [24%] patients, respectively; P = .13), the African American patients had a significantly higher prevalence (96 [64%] vs 62 [41%] patients, respectively; P < .001) and volume (median volume, 2.2 vs 1.4 mL, respectively; P < .001) of noncalcified plaque, independent of diabetes and other cardiovascular risk factors (odds ratio, 2.45; 95% confidence interval: 1.52, 4.04). In contrast, the African American patients had a lower prevalence of calcified plaque (39 [26%] vs 68 [45%] white patients, P = .001).
  
  
  CONCLUSIONS
  Study results suggest that atherosclerotic plaque burden and composition, as measured by using coronary CT angiography, differ between African American and white patients, with relatively more noncalcified disease in African Americans and more calcified disease in white individuals. Further research is warranted to determine whether CT plaque characterization can improve cardiac risk prediction in African Americans.
authors.affiliation: Heart and Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, MSC 226, Charleston, SC 29401, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Nance
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.forename: Doo Kyoung
authors.initials: DK
authors.lastname: Kang
authors.forename: J Michael
authors.initials: JM
authors.lastname: Barraza
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Abro
authors.forename: Gorka
authors.initials: G
authors.lastname: Bastarrika
authors.forename: Gary F
authors.initials: GF
authors.lastname: Headden
authors.forename: Philip
authors.initials: P
authors.lastname: Costello
authors.forename: Christian
authors.initials: C
authors.lastname: Thilo
mesh_terms: D000208:Acute Disease; D001741:Black or African American / Q000706:statistics & numerical data*; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000208:ethnology*; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000208:ethnology*; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011857:Radiographic Image Interpretation, Computer-Assisted; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide