Prof. Ali OTO,MD,FESC,FACC,FHRS

... konulu sunumlar: "Prof. Ali OTO,MD,FESC,FACC,FHRS"— Sunum transkripti:

1 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

2 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.

3 Coronary artery disease:Progression
EEM: external elastic membrane JACC, 2001;38:297–306

4 Coronary atherosclerosis:Remodelling
Early plaque accumulation in human coronary arteries is associated with compensatory enlargement of vessel size (positive remodeling). Negative remodeling and fibrotic changes may be associated with more stable plaques. JACC, 2001;38:297–306

5 Coronary atherosclerosis:Remodelling
Positive remodelling Negative remodelling

6 Remodelling index and vulnerability
Remodelling index is increased in culprit lesions Remodelling index=b/a= 1.26 JACC Imaging 2009;2:153– 60

7 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

8 Which coronary atherosclerotic plaques are more vulnerable ?
Stable coronary atherosclerotic plaque Negative remodelling Clacified plaques More stable plaques JACC 2007;50:319–26 Atherosclerosis 2010; 213:178–183

9 Plaque characteristics in acute coronary syndromes
Positive remodelling, non calcified plaque and spotty calcification are associated with ACS JACC 2007;50:319–26

10 Family history of premature CAD is mainly associated with non-calcified coronary atherosclerotic plaques. Int J Cardiol. 2011; doi: /j.ijcard

11 Coron Artery Dis. 2012 May;23(3):195-200.

12 Addition of non-calcified plaque to clinical variables is superior than clinical variables only in predicting worse outcome. Increased amount of non-calcified plaque is associated with worse prognosis JACC 2011;58:502–9

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

14 Extent of coronary atherosclerotic plaque is associated with worse cardiovascular outcomes
Min JK et al. JACC 2011;58:849–60

15 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

16 MDCT Predictors of MACE
Mean follow-up 29.7±13.2 months (median 33.4; range 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

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

18 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

19 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.