Clinical InvestigationImaging and Diagnostic TestingEfficacy of culprit plaque assessment by 64-slice multidetector computed tomography to predict transient no-reflow phenomenon during percutaneous coronary intervention
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.
References (32)
- et al.
Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography
J Am Coll Cardiol
(2005) - et al.
Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound
J Am Coll Cardiol
(2004) - et al.
Comparison of measurement of cross-sectional coronary atherosclerotic plaque and vessel areas by 16-slice multidetector computed tomography versus intravascular ultrasound
Am J Cardiol
(2004) - et al.
Characterization of vulnerable nonstenotic plaque with 16-slice computed tomography compared with intravascular ultrasound
Am J Cardiol
(2004) - et al.
ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology
J Am Coll Cardiol
(2006) - et al.
Comparison of coronary arterial finding by intravascular ultrasound in patients with “transient no-reflow” versus “reflow” during percutaneous coronary intervention in acute coronary syndrome
Am J Cardiol
(2006) - et al.
Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound
J Am Coll Cardiol
(2006) - et al.
Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound
J Am Coll Cardiol
(2005) - et al.
Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography
J Am Coll Cardiol
(2001) - et al.
Noncardiac findings in cardiac imaging with multidetector computed tomography
J Am Coll Cardiol
(2006)