[Assessment of Coronary Plaques in Patients With Acute Coronary Syndrome Without Persistent ST-Segment Elevation].

ABSTRACT

AIM: to analyze morphological features of atherosclerotic plaques in culprit and non-culprit coronary lesions in patients with non ST-elevation acute coronary syndrome (NSTE-ACS) by multidetector spiral computed tomography (MDCT). RESULTS. In culprit lesions (n = 70) compared to non-culprit lesions (n = 144) frequency of soft plaques (60 vs 43%, p = 0.003), positive remodeling (70.2 vs 54.3%, p = 0.03) and uneven contour (91.7 vs 68.7%, p = 0.0002) were significantly higher. Minimal plaque density was significantly lower and length of plaque was significantly higher in culprit coronary segments (40.1 ± 25.3 vs 74.1 ± 116.8 Hounsfield units [HU], p = 0.02 and 16.8 ± 13.4 vs 13.2 ± 6.9 mm, p = 0.01, respectively). Receiver-operator characteristic curve analysis identified optimal cutoff value of minimum plaque density and length for discrimination between culprit and non-culprit lesion as 40 HU and 13.5 mm, respectively. The combination of soft plaque with a minimal density < 40 HU and uneven contour occurred in one third of culprit lesions and almost two times less in non-culprit (31.67 and 17.91%, respectively, p = 0.04) and was characterized by high specificity (82.1%) and negative predictive value (72.7%). CONCLUSION: The most specific features of culprit lesions in patients with NSTE-ACS were positive vascular remodeling, length > 13.5 mm, minimal CT-density < 40 HU, soft plaque's type and presence of uneven contour, as well as a combination of the last 3 features.