To determine whether the site of acute myocardial infarction (AMI) can be predicted on the basis of a previous coronary angiogram, 184 consecutive angiograms obtained between March 1972 and August 1990 in 92 patients who had undergone coronary angiography both before and after AMI without intervening bypass surgery or angioplasty were evaluated. Median time between the first coronary angiography and AMI was 26 months (range 1 to 144). On the first angiogram, most patients (89%) had 1- or 2-vessel disease, and 56 (61%) had an abnormal ventriculography. Seventy-two segments (78%) responsible for a future AMI were not significantly stenosed. On the second angiogram, AMI was related to the previously most stenotic segments in only 29 patients (32%). For these patients, median time between first coronary angiography and AMI was slightly shorter (22 vs 28 months; p = 0.04). The severity of the narrowing on the first angiogram was a poor predictor of subsequent AMI. It is concluded that in a selected, medically treated cohort, AMI is frequently related to a segment that was not the most stenotic one or was not even significantly stenosed at previous angiography, particularly with a long interval between the first angiogram and AMI.
"Different diagnostic tools have been used to detect CAD, such as exercise testing or pharmacologic cardiac imaging (nuclear or echocardiography), which can only detect high-grade coronary stenosis. As we know, the severity of narrowing observed in coronary angiographic images is a poor predictor of subsequent acute myocardial infarction, and about 60% to 83% of heart attacks occur at the site of a non-obstructive plaque. These diagnostic tools cannot identify a vast number of asymptomatic at-risk patients. "
[Show abstract][Hide abstract] ABSTRACT: Background
Multidetector computed tomography (MDCT) coronary angiography represents one of the most exciting technological revolutions in cardiac imaging and it has been increasingly used in the diagnosis of coronary artery disease. The purpose of this study is to investigate the effect of age and coronary plaque calcification on diagnostic accuracy of MDCT.
The patients were examined by using dual-source MDCT and conventional coronary angiography. MDCT results were analyzed with regard to the severity (> 50% stenosis) and morphology (non-calcified, mixed, or calcified) of coronary atherosclerotic plaques evaluated in a 16-segment model.
In total, 181 patients (94 men and 87 women) with 2,687 coronary artery segments were examined with MDCT. Ninety three patients were older than 65 years of age (group A, 42 men) and 88 were younger (group B, 52 men). Two-hundred nine coronary artery segments (7.2%) were excluded because of small distal coronary vessel segments and/or motion artifacts. The overall number of segments with non-diagnostic image quality was similar in both groups of patients. Of the 2,687 evaluated segments, 157 (5.8%) were significantly diseased, and 144 of them were correctly detected by MDCT. Diagnostic evaluation showed that the sensitivity, positive predictive value, specificity, and negative predictive value were 89.5%, 62.5%, 96.0%, and 99.2%, respectively in group A, and 95.2%, 64.8%, 97.5%, and 99.8% in group B, respectively. In addition, detailed segment-based analyses in coronary segments with non-calcified, mixed and calcified plaques in both groups were similar diagnostic accuracy.
Very high diagnostic accuracy observed in this study suggests that MDCT coronary angiography could be a suitable diagnostic tool for not only younger patients but also for older patients.
"Cardiovascular disease is the leading cause of mortality throughout the world, with studies showing cardiovascular disease to be the cause of death in 30% of all mortalities reported in the USA.1 Atherosclerosis is a disease process that begins at an early age and is progressive in nature. Atherosclerotic lesions do not arouse any symptoms in the early stage, but its initial presentation may result in catastrophic cardiovascular events resulting from plaque rupture.2 As such, it is imperative to identify subjects at increased risk of cardiovascular disease and modify their risk factors early on. "
[Show abstract][Hide abstract] ABSTRACT: Primary prevention and early detection of cardiovascular disease is important, as it is the leading cause of death throughout world. Risk stratification algorithms, such as Framingham Risk Score and European Systematic Coronary Risk Evaluation, that utilize a combination of various traditional risk factors have been developed to improve primary prevention. However, the accuracy of these algorithms for screening high risk patients is moderate at best. Accordingly, the use of biomarkers or imaging studies may improve risk stratification. Carotid ultrasound, which measures both carotid intima-media thichkness (cIMT) and carotid plaque, is useful in detecting the degree of subclinical carotid atherosclerosis, and has the advantage of being noninvasive and safe. Several large epidemiologic studies have indicated that cIMT and carotid plaque are closely related with other cardiovascular risk factors and may be useful for risk reclassification in subjects deemed to be at intermediate risk by traditional risk scores. Moreover, recent clinical guidelines for management of hypertension or dyslipidemia highlight the usefulness of cIMT in high risk patients. In this article, we review evidence for the usefulness of measurement of cIMT and carotid plaque for cardiovascular risk stratification.
Yonsei medical journal 05/2014; 55(3):551-7. DOI:10.3349/ymj.2014.55.3.551 · 1.29 Impact Factor
"Previous studies have found that numerous coronary lesions in patients with coronary heart disease are non-obstructive and vessels with mild to moderate stenosis are responsible for cardiac events (20,21). The vulnerability of intracoronary lesions is a key factor for acute cardiac events in these patients with mild to moderate stenosis (20,21). Acute coronary syndrome is often caused by rupture of coronary artery atherosclerosis plaques, rather than lumen stenosis (22). "
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to investigate the predictive value of multi-detector computed tomography angiography (MDCTA) on acute coronary artery events in patients with type 2 diabetes mellitus (T2DM). MDCTA was performed in 150 patients with T2DM (males, 74; mean age, 66±6.7 years for all patients) that had experienced atypical chest pains. After a follow-up period of at least 2 years, 55 patients were excluded from the study as they did not exhibit any coronary events. The remaining 95 patients were divided into the study group (n=28), that had experienced an acute coronary event such as acute coronary syndrome, or the control group (n=67) that had stable angina. There were no statistically significant differences in the degree of coronary artery lumen stenosis between the study and control groups (P=0.380). The proportion of calcified plaques in the study group was significantly lower compared with the control group (13.6 vs. 53.2%; P<0.001), while the proportion of soft plaques in the study group was significantly higher compared with the control group (37 vs. 9.3%; P<0.001). Type III plaques showed a sensitivity of 76.2% and a negative predictive value of 64.5% for acute coronary events. By contrast, type IV plaques had a sensitivity of 52.6% and a positive predictive value of 63% for chronic coronary events. Therefore, the results of the present study indicate that MDCTA may be used as a noninvasive modality for evaluating and predicting vulnerable coronary atherosclerosis plaques in patients with T2DM.
Experimental and therapeutic medicine 04/2014; 7(4):917-922. DOI:10.3892/etm.2014.1502 · 1.27 Impact Factor
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