27 Oct 22. Featured Paper

Link to paper in Radiology: Cardiothoracic Imaging

Authors

Meah MN, Bularga A, Tzolos E, Chapman AR, Daghem M, Hung JD, Chiong J, Taggart C, Wereski R, Gray A, Dweck MR, Roobottom C, Curzen N, Kardos A, Felmeden D, Mills NL, Slomka PJ, Newby DE, Dey D, Williams MC

Abstract

PURPOSE: To determine whether quantitative plaque characterization using CT coronary angiography (CTCA) can discriminate between type 1 and type 2 myocardial infarction.

METHODS: This was a secondary analysis of two prospective studies (ClinicalTrials.gov: NCT03338504 (2014-2019) and NCT02284191 (2018-2020)) that performed blinded quantitative plaque analysis on CTCA of participants with type 1 myocardial infarction, type 2 myocardial infarction, and chest pain without myocardial infarction. Logistic regression analyses were performed to identify predictors of type 1 myocardial infarction.

RESULTS: Overall, 155 participants (mean age, 64 ± [SD] 12 years; 114 men) and 36 participants (mean age, 67 ±12 years; 19 men) had type 1 and type 2 myocardial infarction respectively, and 136 (62 ± 12 years; 78 men) had chest pain without myocardial infarction. Participants with type 1 myocardial infarction had greater total (median, 44% [IQR, 35-50%] versus 35% [29-46%]), non-calcified (39% [31-46%] versus 34% [29-40%]) and low-attenuation (4.15% [1.88-5.79%] versus 1.64% [0.89-2.28%]) plaque burdens (p<0.05 for all) than those with type 2. Participants with type 2 myocardial infarction had similar low-attenuation plaque burden to those with chest pain without myocardial infarction (p=0.4). Low-attenuation plaque was an independent predictor of type 1 myocardial infarction (adjusted odds ratio, 3.44 [95% CI 1.84-6.96]; p<0.001), with better discrimination than non-calcified plaque burden and maximal area of coronary stenosis (c-statistic 0.75 [0.67-0.83] versus 0.62 [0.53-0.71] and 0.61 [0.51-0.70] respectively; P£0.001 for both).

CONCLUSION: Higher coronary low-attenuation plaque burden in patients with type I myocardial infarction may help distinguish these patients from those with type 2 myocardial infarction.

Keywords

• Ischemia
• Infarction
• CT Angiography
• Quantitative CT

Citation

Distinguishing Type 1 from Type 2 Myocardial Infarction by Using CT Coronary Angiography. Mohammed N. Meah, Anda Bularga, Evangelos Tzolos, Andrew R. Chapman, Marwa Daghem, John D. Hung, Justin Chiong, Caelan Taggart, Ryan Wereski, Alasdair Gray, Marc R. Dweck, Carl Roobottom, Nick Curzen, Attila Kardos, Dirk Felmeden, Nicholas L. Mills, Piotr J. Slomka, David E. Newby, Damini Dey, and Michelle C. Williams. Radiology: Cardiothoracic Imaging 2022 4:5. https://pubs.rsna.org/doi/abs/10.1148/ryct.220081