title: High-risk carotid plaques identified by CT-angiogram can predict acute myocardial infarction.
abstract: Prior studies identified the incremental value of non-invasive imaging by CT-angiogram (CTA) to detect high-risk coronary atherosclerotic plaques. Due to their superficial locations, larger calibers and motion-free imaging, the carotid arteries provide the best anatomic access for the non-invasive characterization of atherosclerotic plaques. We aim to assess the ability of predicting obstructive coronary artery disease (CAD) or acute myocardial infarction (MI) based on high-risk carotid plaque features identified by CTA. We retrospectively examined carotid CTAs of 492 patients that presented with acute stroke to characterize the atherosclerotic plaques of the carotid arteries and examined development of acute MI and obstructive CAD within 12-months. Carotid lesions were defined in terms of calcifications (large or speckled), presence of low-attenuation plaques, positive remodeling, and presence of napkin ring sign. Adjusted relative risks were calculated for each plaque features. Patients with speckled (<3 mm) calcifications and/or larger calcifications on CTA had a higher risk of developing an MI and/or obstructive CAD within 1 year compared to patients without (adjusted RR of 7.51, 95%CI 1.26-73.42, P = 0.001). Patients with low-attenuation plaques on CTA had a higher risk of developing an MI and/or obstructive CAD within 1 year than patients without (adjusted RR of 2.73, 95%CI 1.19-8.50, P = 0.021). Presence of carotid calcifications and low-attenuation plaques also portended higher sensitivity (100 and 79.17%, respectively) for the development of acute MI. Presence of carotid calcifications and low-attenuation plaques can predict the risk of developing acute MI and/or obstructive CAD within 12-months. Given their high sensitivity, their absence can reliably exclude 12-month events.
authors.affiliation: Division of Cardiology, Clinical & Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA. wassim.mosleh@gmail.com.
authors.forename: Wassim
authors.initials: W
authors.lastname: Mosleh
authors.affiliation: Division of Cardiology, Clinical & Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA.
authors.forename: Keenan
authors.initials: K
authors.lastname: Adib
authors.affiliation: Division of Cardiology, Clinical & Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA.
authors.forename: Punnanithinont
authors.initials: P
authors.lastname: Natdanai
authors.affiliation: Division of Cardiology, Clinical & Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Carmona-Rubio
authors.affiliation: Division of Cardiology, Clinical & Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA.
authors.forename: Roshan
authors.initials: R
authors.lastname: Karki
authors.affiliation: Division of Cardiology, Clinical & Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA.
authors.forename: Jacienta
authors.initials: J
authors.lastname: Paily
authors.affiliation: Division of Cardiology, Clinical & Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA.
authors.forename: Mohamed Abdel-Aal
authors.initials: MA
authors.lastname: Ahmed
authors.affiliation: Division of Cardiology, Clinical & Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA.
authors.forename: Sujit
authors.initials: S
authors.lastname: Vakkalanka
authors.affiliation: Division of Cardiology, Clinical & Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA.
authors.forename: Narasa
authors.initials: N
authors.lastname: Madam
authors.affiliation: Division of Cardiology, Clinical & Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Gudleski
authors.affiliation: Division of Cardiology, Clinical & Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Chung
authors.affiliation: Division of Cardiology, Clinical & Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA.
authors.forename: Umesh C
authors.initials: UC
authors.lastname: Sharma
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D000072226:Computed Tomography Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology*; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012422:Rupture, Spontaneous; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging
keywords: CT-angiogram; Carotid plaques; Imaging; Myocardial infraction