Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Clinical Investigation
Assessing Culprit Lesions and Active Complex Lesions in Patients With Early Acute Myocardial Infarction by Multidetector Computed Tomography
Wei-Chun Huang, Ming-Ting Wu, Kuan-Rau Chiou, Guang-Yuan Mar, Shih-Hung Hsiao, Shih-Kai Lin, Tung-Cheng Yeh, Yi-Luan Huang, Hsiang-Chiang Hsiao, Doyal Lee, Chuen-Wang Chiou, Shoa-Lin Lin, Chun-Peng Liu
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Keywords: Acute myocardial infarction, Culprit lesions, Multidetector row computed tomography, Remodeling index
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2008 Volume 72 Issue 11 Pages 1806-1813

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Abstract

Background Accurate, non-invasive characterization of culprit lesions in patients after acute myocardial infarction (AMI) remains challenging. In this prospective study, multidetector row computed tomography (MDCT) is used to assess culprit and active complex lesions in patients early after AMI. Methods and Results We enrolled 103 patients with first non ST-elevation AMI who underwent 64-slices MDCT and conventional coronary angiography (CCAG). The definition of culprit lesion, stable non-culprit lesions and non-culprit active complex lesions was based on the findings of CCAG. The lesions were analyzed with MDCT data. In culprit lesions (n=103), luminal artery stenosis, remodeling index, plaque area and burden were significantly higher than non-culprit lesions (n=129). Multivariate discriminant analysis showed that MDCT density could discriminate culprit from non-culprit lesions. Receiver-operator characteristic curve analysis identified the optimal cutoff value of lesion density for discrimination between culprit and non-culprit lesion as 49.6 Hounsfield units (HU); this value was associated with a sensitivity, specificity and accuracy of 88.4%, 87.4%, and 87.9%, respectively. The MDCT in the stable non-culprit lesions (81.8±15.5 HU) was significantly higher than that in culprit lesions or non-culprit active complex lesions (33.2±13.8 and 48.3±15.7 HU, p<0.001). Conclusions MDCT can predict culprit lesions in patients early after AMI, and identify multiple complex lesions. (Circ J 2008; 72: 1806 - 1813)

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© 2008 THE JAPANESE CIRCULATION SOCIETY
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