Prognostic Significance of Subtle Obstructive Lesions in Multislice CT Coronary Angiography Prof. Ali OTO,MD,FESC,FACC,FHRS Hacettepe University, Department of Cardiology Ankara, Turkey

I/we have no real or apparent conflicts of interest to report. Ali Oto, MD I/we have no real or apparent conflicts of interest to report.

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Which coronary atherosclerotic plaques are more vulnerable ? Unstable plaque r l l/r >1.05 Positive remodelling in the coronary vessel JACC 2007;50:319–26

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Non-obstructive CAD had worse prognosis than patients with normal coronary arteries

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Prospectively enrolled consecutive subset of 1115 symptomatic patients MDCT coronary angiography was performed for the suspicion of CAD after clinical assessment Exclusion criteria: Hx of previous CAD or MI, patients already treated with PCI or CABG, heart failure, renal dysfunction (creat≥1.5 mg/dL), neoplastic diseases and rhythm disorders other than stable sinus rhythm Patients with critical stenosis which was shown either by conventional CAG or MDCT angiography (>70%) were not included in the study. Yorgun H. Int J Cardiology,2012

MDCT Predictors of MACE Mean follow-up 29.7±13.2 months (median 33.4; range 6.1-53.3 months). Multivariable Cox proportional hazard analysis Variable Hazards Ratio (CI) P value CAP severity <%50 %50-%70 4,77 (1,36-16,74) 3,28 (0,89-11,99) 0,049 0,015 0,073 Extent of CAP 1,08 (0,98-1,20) 0,120 Yorgun H. Int J Cardiology,2012

Survival Analysis P=0.02 P<0.05 Yorgun H. Int J Cardiology,2012

Takipteki hastalarımızdan, 48 yaşında göğüs ağrısı ile bölümümüze başvuran erkek hastanın koroner BT anjiyografisinde (A) Maksimum intansite projeksiyon görüntülerde LAD proksimalinde kalsifik olmayan ve kritik darlığa yol açmayan plak izlenmektedir (siyah ok). Aynı zamanda plakta noktasal kalsifikasyonlar da mevcuttur (beyaz oklar). (B) Üç boyutlu volume rendering görüntülerde LAD proksimalindeki plak gözlenmektedir (siyah oklar). (C) Maksimum intansite projeksiyon görüntülerde LAD proksimalindeki kalsifik olmayan plak izlenmektedir. (D) ÇKBTA çekildikten 27 ay sonra göğüs ağrısı şikayeti ile acil servise başvuran hastaya akut koroner sendrom tanısıyla koroner anjiyografisi yapılmış ve LAD proksimalinde total oklüzyon saptanmıştı. Balon anjiyoplasti sonrası LAD proksimalindeki kritik lezyona 3.0 X 23 mm ilaç kapsız stent implante edilmiştir. 48 years old male patient admitted to our department with chest pain and MDCT revealed noncalcified plaque of no hemodynamic significance (A,B,C). 27 months later, he admitted to emergency room with acute coronary syndrome (D). Yorgun H. Int J Cardiology,2012

Conclusions Dual source MDCT is useful in the prognostic assessment of patients with suspected CAD. The presence, severity, extent and morphology of CAPs shown by MDCT are related to the prognosis of coronary events in the follow-up. Imaging of CAPs may contribute to the clinical assessment to identify patients at greater risk of acute coronary events apart from traditional cardiovascular risk factors.