Evaluation of plaque texture by means of multislice computed tomography in patients with acute coronary syndrome and stable angina

Background In the present study, multislice spiral computed tomography (MSCT), which allows non-invasive assessment of coronary artery plaque, was used to compare the CT density of plaque between patients with acute coronary syndrome (ACS) and those with stable angina (SA). Methods and Results MSCT was performed in 20 patients with ACS (17 with acute myocardial infarction, 3 with unstable angina) and 22 patients with SA. The presence of the plaque was defined on the basis of multiplanar reformation and axial images. At least 4 regions of interest were then placed within the plaque and the minimum CT density was measured and expressed as Hounsfield units (HU). The number of plaques did not differ between the 2 groups, but the minimum CT density was significantly lower in patients with ACS (25 +/- 15 HU) than in those with SA (71 +/- 16HU, range 46-101 HU, p < 0.001). Similarly, the minimum plaque density was significantly lower in the culprit coronary segment (26 +/- 16 HU) than in the non-culprit segment (48 +/- 17 HU) in 15 ACS patients with multiple plaques. Conclusion MSCT can potentially differentiate vulnerable from stable plaque in patients with coronary artery disease, although long-term, prospective analysis is needed to establish the conclusion.