title: Plaque disruption by coronary computed tomographic angiography in stable patients vs. acute coronary syndrome: a feasibility study.
abstract: OBJECTIVE
  This study was designed to determine whether coronary CT angiography (CTA) can detect features of plaque disruption in clinically stable patients and to compare lesion prevalence and features between stable patients and those with acute coronary syndrome (ACS).
  
  
  METHODS
  We retrospectively identified patients undergoing CTA, followed by invasive coronary angiography (ICA) within 60 days. Quantitative 3-vessel CTA lesion analysis was performed on all plaques ≥25% stenosis to assess total plaque volume, low attenuation plaque (LAP, <50 HU) volume, and remodelling index. Plaques were qualitatively assessed for CTA features of disruption, including ulceration and intra-plaque dye penetration (IDP). ICA was employed as a reference standard for disruption. A total of 145 (94 ACS and 51 stable) patients were identified. By CTA, plaque disruption was evident in 77.7% of ACS cases. Although more common among those with ACS, CTA also detected plaque disruption in 37.3% of clinically stable patients (P < 0.0001).
  
  
  CONCLUSIONS
  Clinically stable patients commonly manifest plaques with features of disruption as determined by CTA. Though the prevalence of plaque disruption is less than patients with ACS, these findings support the concept that some clinically stable patients may harbour 'silent' disrupted plaques. These findings may have implications for detection of 'at risk' plaques and patients.
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health System, 3601 W. Thirteen Mile Road, Royal Oak, MI 48073, USA abhay.bilolikar@beaumont.edu.
authors.forename: Abhay N
authors.initials: AN
authors.lastname: Bilolikar
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health System, 3601 W. Thirteen Mile Road, Royal Oak, MI 48073, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Goldstein
authors.affiliation: Frederik Meijer Heart and Vascular Institute, Spectrum Health Medical Center, Grand Rapids, MI, USA.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Madder
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health System, 3601 W. Thirteen Mile Road, Royal Oak, MI 48073, USA.
authors.forename: Kavitha M
authors.initials: KM
authors.lastname: Chinnaiyan
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000368:Aged; D017023:Coronary Angiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Acute coronary syndrome; Coronary computed tomographic angiography; Plaque characterization; Stable angina; Vulnerable plaque