Elsevier

American Heart Journal

Volume 155, Issue 6, June 2008, Pages 1150-1157
American Heart Journal

Clinical Investigation
Imaging and Diagnostic Testing
Efficacy of culprit plaque assessment by 64-slice multidetector computed tomography to predict transient no-reflow phenomenon during percutaneous coronary intervention

https://doi.org/10.1016/j.ahj.2008.01.006Get rights and content

Background

It has been reported that multidetector spiral computed tomography (MDCT) allows the classification of coronary plaques by measuring computed tomography (CT) density values. However, the impact of CT density values in culprit lesions on the occurrence of transient no-reflow during percutaneous coronary intervention (PCI) has not been investigated.

Methods

The study population consisted of 51 consecutive patients who were diagnosed as having coronary artery disease by 64-slice MDCT before PCI. The CT density values were measured in multiple cross-sectional images along the plaque by 5-pixel regions of interest at multiple sites in the culprit plaque. The measurements were performed by 2 physicians who were unaware of the outcome of PCI. In addition, we describe a new observation noted on MDCT: from the formal resemblance to a ring, we dubbed these images as showing a “signet ring–like appearance.”

Results

Of the total 51 patients, 9 had transient no-reflow during the procedure. There was a significant difference in CT density of the culprit plaque between patients with transient no-reflow and those without (67.0 ± 10.1 vs 97.8 ± 37.2 Hounsfield units, P = .018). In addition, a signet ring–like appearance was observed more frequently in patients with transient no-reflow (55.6% vs 16.7%, P = .013). By multivariate analysis, low CT density value and ejection fraction were identified as independent predictors of transient no-reflow.

Conclusions

The assessment of plaque characteristics by MDCT might be useful for the prediction of transient no-reflow during PCI.

Section snippets

Patients

From November 2004 to December 2005, 599 patients with stable angina symptom and/or electrocardiogram abnormality underwent noninvasive coronary imaging using 64-slice MDCT scanner. In this population, we identified 51 patients who were diagnosed as having a stable coronary artery disease and subsequently underwent PCI. Patients with extensively calcified lesions, previously stented lesions, or presented with acute coronary syndrome were excluded. Patients with a prior history of coronary

Patient, lesion, and procedural characteristics

Patients were classified into 2 groups according to the presence or absence of transient no-reflow during the procedure. Of the total 51 patients, there were 9 patients who had transient no-reflow during the procedure. Patient characteristics were comparable except for previous PCI and ejection fraction (Table I), with previous PCI being more common and ejection fraction lower in the group with transient no-reflow. Lesion and procedure characteristics and postprocedure cardiac enzyme changes

Discussion

The present study demonstrates that patients who had transient no-reflow during the procedure had lower plaque CT density values in culprit lesions. Multidetector spiral computed tomography permits an accurate noninvasive detection of coronary artery stenosis.1, 2, 3, 4 Furthermore, it has been demonstrated to allow the detection and classification of plaques.5, 12, 20, 21 Leber et al6, 13 and Schroeder et al14 consistently reported that CT density values measured within plaques reflect the

Conclusions

The CT density of plaque in patients with transient no-reflow in PCI is lower than in patients without transient no-reflow. A ring-like formation on the cross-sectional MDCT images, dubbed the signet ring–like appearance, is more frequently observed in patients with transient no-reflow. Our results suggest that MDCT may provide a useful tool for predicting when no-reflow will occur during PCI, although further investigation is necessary.

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