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High-risk carotid plaques identified by CT-angiogram can predict acute myocardial infarction

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Abstract

Prior studies identified the incremental value of non-invasive imaging by CT-angiogram (CTA) to detect high-risk coronary atherosclerotic plaques. Due to their superficial locations, larger calibers and motion-free imaging, the carotid arteries provide the best anatomic access for the non-invasive characterization of atherosclerotic plaques. We aim to assess the ability of predicting obstructive coronary artery disease (CAD) or acute myocardial infarction (MI) based on high-risk carotid plaque features identified by CTA. We retrospectively examined carotid CTAs of 492 patients that presented with acute stroke to characterize the atherosclerotic plaques of the carotid arteries and examined development of acute MI and obstructive CAD within 12-months. Carotid lesions were defined in terms of calcifications (large or speckled), presence of low-attenuation plaques, positive remodeling, and presence of napkin ring sign. Adjusted relative risks were calculated for each plaque features. Patients with speckled (<3 mm) calcifications and/or larger calcifications on CTA had a higher risk of developing an MI and/or obstructive CAD within 1 year compared to patients without (adjusted RR of 7.51, 95%CI 1.26–73.42, P = 0.001). Patients with low-attenuation plaques on CTA had a higher risk of developing an MI and/or obstructive CAD within 1 year than patients without (adjusted RR of 2.73, 95%CI 1.19–8.50, P = 0.021). Presence of carotid calcifications and low-attenuation plaques also portended higher sensitivity (100 and 79.17%, respectively) for the development of acute MI. Presence of carotid calcifications and low-attenuation plaques can predict the risk of developing acute MI and/or obstructive CAD within 12-months. Given their high sensitivity, their absence can reliably exclude 12-month events.

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Abbreviations

ACS:

Acute coronary syndrome

BMI:

Body mass index

CHF:

Congestive heart failure

CTA:

CT angiogram

CVA:

Cerebrovascular accident

DM:

Diabetes mellitus

HTN:

Hypertension

HLP:

Hyperlipidemia

LVEF:

Left ventricular ejection fraction

MI:

Myocardial infarction

MRA:

Magnetic resonance angiogram

NRS:

Napkin-ring sign

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Acknowledgements

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award Number Kl2TR001413.  The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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    Authors and Affiliations

    1. Division of Cardiology, Clinical & Translational Research Center, University at Buffalo, 875 Ellicott Street, Suite 7030, Buffalo, NY, 14203, USA

      Wassim Mosleh, Keenan Adib, Punnanithinont Natdanai, Andres Carmona-Rubio, Roshan Karki, Jacienta Paily, Mohamed Abdel-Aal Ahmed, Sujit Vakkalanka, Narasa Madam, Gregory D. Gudleski, Charles Chung & Umesh C. Sharma

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    Wassim Mosleh and Keenan Adib have contributed equally to this work.

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    Mosleh, W., Adib, K., Natdanai, P. et al. High-risk carotid plaques identified by CT-angiogram can predict acute myocardial infarction. Int J Cardiovasc Imaging 33, 561–568 (2017). https://doi.org/10.1007/s10554-016-1019-5

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