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Original Articles

Evaluation of Coronary Atherosclerosis by Multislice Computed Tomography in Patients With Acute Myocardial Infarction and Without Significant Coronary Artery Stenosis

A Comparative Study With Quantitative Coronary Angiography

Annachiara Aldrovandi, MD; Filippo Cademartiri, MD, PhD; Alberto Menozzi, MD; Fabrizio Ugo, MD; Daniela Lina, MD; Erica Maffei, MD; Alessandro Palumbo, MD; Michele Fusaro, MD; Girolamo Crisi, MD and Diego Ardissino, MD

From the Division of Cardiology (A.A., A.M., F.U., D.L., D.A.), Department of Heart and Lung, and Department of Radiology (F.C., E.M., A.P., M.F., G.C.), Azienda Ospedaliero-Universitaria di Parma, Italy.

Correspondence to Annachiara Aldrovandi, MD, Division of Cardiology, Department of Heart and Lung, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy. E-mail aldrovandiac{at}yahoo.it

Received April 22, 2008; accepted September 24, 2008.

Background— It is known that 9% to 31% of women and 4% to 14% of men with acute myocardial infarction have normal coronary arteries or nonsignificant coronary disease at angiography. These patients represent a diagnostic and therapeutic challenge. Multislice computed tomography (CT) can noninvasively identify the presence of coronary plaques even in the absence of significant coronary artery stenosis. This study evaluated the role of 64-slice CT, in comparison with coronary angiography, in detecting and characterizing coronary atherosclerosis in patients with acute myocardial infarction without significant coronary artery stenosis.

Methods and Results— Thirty consecutive patients with acute myocardial infarction but without significant coronary stenosis at coronary angiography underwent 64-slice CT. All coronary segments were quantitatively analyzed by means of coronary angiography (CA-QCA) and 64-slice CT (CT-QCA). Forty-seven (10.4%) of the 450 coronary segments were not evaluable by CT. The mean proximal reference diameters at CT-QCA and CA-QCA were, respectively, 2.88±0.75 mm and 2.65±0.9 mm; the overall correlation between CT-QCA and CA-QCA for quantification of reference diameter was r_s=0.77; P<0.001. The mean percent stenosis was 14.4±8.0% at CT-QCA and 4.0±11.0% at CA-QCA and the correlation was r_s=0.11; P=0.03. Overall CT-QCA showed the presence of 50 plaques, of which only 11 were detected by CA-QCA. CT-QCA identified 25 plaques in infarct-related coronary arteries. Positive remodeling was present in 38 of the 50 plaques (76%), with a higher prevalence in the coronary plaques not visualized by CA-QCA (82.1% versus 54.5%).

Conclusions— CT-QCA correlates well with CA-QCA in terms of coronary reference diameter analysis, but not stenosis quantification. Multislice CT can detect coronary atherosclerotic plaques in segments of nonstenotic coronary arteries that are underestimated by CA and may have an incremental diagnostic value for the diagnosis of acute myocardial infarction in patients without significant coronary stenosis at CA.

Key Words: angiography • coronary disease • imaging • myocardial infarction

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Related Article

Evaluation of Coronary Atherosclerosis by Multislice Computed Tomography in Patients With Acute Myocardial Infarction and Without Significant Coronary Artery Stenosis: A Comparative Study With Quantitative Coronary Angiography

Annachiara Aldrovandi, Filippo Cademartiri, Alberto Menozzi, Fabrizio Ugo, Daniela Lina, Erica Maffei, Alessandro Palumbo, Michele Fusaro, Girolamo Crisi, and Diego Ardissino
Circ Cardiovasc Imaging 2008 1: 205-211. [Abstract] [Full Text] [PDF]