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Distinguishing type 1 from type 2 myocardial infarction by using CT coronary angiography

Distinguishing type 1 from type 2 myocardial infarction by using CT coronary angiography
Distinguishing type 1 from type 2 myocardial infarction by using CT coronary angiography

Purpose: to determine whether quantitative plaque characterization by using CT coronary angiography (CTCA) can discriminate between type 1 and type 2 myocardial infarction. 

Materials and Methods: this was a secondary analysis of two prospective studies (ClinicalTrials.gov registration nos. NCT03338504 [2014–2019] and NCT02284191 [2018–2020]) that performed blinded quantitative plaque analysis on findings from CTCA in participants with type 1 myocardial infarction, type 2 myocardial infarction, and chest pain without myocardial infarction. Logistic regression analyses were performed to identify predictors of type 1 myocardial infarction. 

Results: overall, 155 participants (mean age, 64 years 6 12 [SD]; 114 men) and 36 participants (mean age, 67 years 6 12; 19 men) had type 1 and type 2 myocardial infarction, respectively, and 136 participants (62 years 6 12; 78 men) had chest pain without myocardial infarction. Participants with type 1 myocardial infarction had greater total (median, 44% [IQR: 35%–50%] vs 35% [IQR: 29%–46%]), noncalcified (39% [IQR: 31%–46%] vs 34% [IQR: 29%–40%]), and low-attenuation (4.15% [IQR: 1.88%–5.79%] vs 1.64% [IQR: 0.89%–2.28%]) plaque burdens (P <.05 for all) than those with type 2. Participants with type 2 myocardial infarction had similar low-attenuation plaque burden to those with chest pain without myocardial infarction (P =.4). Low-attenuation plaque was an independent predictor of type 1 myocardial infarction (adjusted odds ratio, 3.44 [95% CI: 1.84, 6.96]; P <.001), with better discrimination than noncalcified plaque burden and maximal area of coronary stenosis (C statistic, 0.75 [95% CI: 0.67, 0.83] vs 0.62 [95% CI: 0.53, 0.71] and 0.61 [95% CI: 0.51, 0.70] respectively; P ≤.001 for both). 

Conclusion: higher low-attenuation coronary plaque burden in patients with type 1 myocardial infarction may help distinguish these patients from those with type 2 myocardial infarction.

CT Angiography, Ischemia/Infarction, Quantitative CT
Meah, Mohammed N.
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Bularga, Anda
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Tzolos, Evangelos
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Chapman, Andrew R.
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Daghem, Marwa
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Hung, John D.
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Chiong, Justin
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Taggart, Caelan
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Wereski, Ryan
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Gray, Alasdair
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Dweck, Marc R.
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Roobottom, Carl
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Curzen, Nick
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Kardos, Attila
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Felmeden, Dirk
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Mills, Nicholas L.
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Slomka, Piotr J.
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Newby, David E.
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Dey, Damini
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Williams, Michelle C.
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Meah, Mohammed N.
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Bularga, Anda
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Tzolos, Evangelos
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Chapman, Andrew R.
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Daghem, Marwa
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Hung, John D.
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Chiong, Justin
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Taggart, Caelan
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Wereski, Ryan
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Gray, Alasdair
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Dweck, Marc R.
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Roobottom, Carl
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Curzen, Nick
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Kardos, Attila
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Felmeden, Dirk
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Mills, Nicholas L.
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Slomka, Piotr J.
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Newby, David E.
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Dey, Damini
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Williams, Michelle C.
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Meah, Mohammed N., Bularga, Anda, Tzolos, Evangelos, Chapman, Andrew R., Daghem, Marwa, Hung, John D., Chiong, Justin, Taggart, Caelan, Wereski, Ryan, Gray, Alasdair, Dweck, Marc R., Roobottom, Carl, Curzen, Nick, Kardos, Attila, Felmeden, Dirk, Mills, Nicholas L., Slomka, Piotr J., Newby, David E., Dey, Damini and Williams, Michelle C. (2022) Distinguishing type 1 from type 2 myocardial infarction by using CT coronary angiography. Radiology: Cardiothoracic Imaging, 4 (5), [e220081]. (doi:10.1148/ryct.220081).

Record type: Article

Abstract

Purpose: to determine whether quantitative plaque characterization by using CT coronary angiography (CTCA) can discriminate between type 1 and type 2 myocardial infarction. 

Materials and Methods: this was a secondary analysis of two prospective studies (ClinicalTrials.gov registration nos. NCT03338504 [2014–2019] and NCT02284191 [2018–2020]) that performed blinded quantitative plaque analysis on findings from CTCA in participants with type 1 myocardial infarction, type 2 myocardial infarction, and chest pain without myocardial infarction. Logistic regression analyses were performed to identify predictors of type 1 myocardial infarction. 

Results: overall, 155 participants (mean age, 64 years 6 12 [SD]; 114 men) and 36 participants (mean age, 67 years 6 12; 19 men) had type 1 and type 2 myocardial infarction, respectively, and 136 participants (62 years 6 12; 78 men) had chest pain without myocardial infarction. Participants with type 1 myocardial infarction had greater total (median, 44% [IQR: 35%–50%] vs 35% [IQR: 29%–46%]), noncalcified (39% [IQR: 31%–46%] vs 34% [IQR: 29%–40%]), and low-attenuation (4.15% [IQR: 1.88%–5.79%] vs 1.64% [IQR: 0.89%–2.28%]) plaque burdens (P <.05 for all) than those with type 2. Participants with type 2 myocardial infarction had similar low-attenuation plaque burden to those with chest pain without myocardial infarction (P =.4). Low-attenuation plaque was an independent predictor of type 1 myocardial infarction (adjusted odds ratio, 3.44 [95% CI: 1.84, 6.96]; P <.001), with better discrimination than noncalcified plaque burden and maximal area of coronary stenosis (C statistic, 0.75 [95% CI: 0.67, 0.83] vs 0.62 [95% CI: 0.53, 0.71] and 0.61 [95% CI: 0.51, 0.70] respectively; P ≤.001 for both). 

Conclusion: higher low-attenuation coronary plaque burden in patients with type 1 myocardial infarction may help distinguish these patients from those with type 2 myocardial infarction.

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e-pub ahead of print date: 27 October 2022
Additional Information: Funding Information: Disclosures of conflicts of interest: M.M. Author is a British Heart Foundation (BHF) clinical research fellow at the University of Edinburgh, a BHF grant (grant no. FS/19/46/34445) has supported author’s work since November 2019. A.B. Support for the present manuscript from the BHF (grant no. FS/16/75/32533). E.T. No relevant relationships. A.R.C. No relevant relationships. M.D. No relevant relationships. J.D.H. No relevant relationships. J.C. No relevant relationships. C.T. No relevant relationships. R.W. Clinical training research fellowship from the Medical Research Council UK (no. MR/V007017/1). A.G. Participation on advisory board for Abbott for brain and cardiac biomarkers, fees paid to author’s institution. M.R.D. No relevant relationships. C.R. No relevant relationships. N.C. Unrestricted research grants from Boston Scientific, Haemonetics, Beckmann Coulter, and HeartFlow; speakers fees from Abbott and Boston Scientific; travel sponsorship from Biosensors, Abbott, Edwards, and Medtronic. A.K. No relevant relationships. D.F. No relevant relationships. N.L.M. BHF grants (grant nos. CH/F/21/90010, RG/20/10/34966, and RE/18/5/34216) paid to author’s institution; payment or honoraria for lectures from Abbott Diagnostics and Siemens Healthineers; payment for participation on advisory boards for LumiraDX, Roche Diagnostics, and Siemens Healthineers; receipt of reagent from Siemens Healthineers to support research. P.J.S. Grants from Siemens Medical Systems and National Institutes of Health, paid to author’s institution; royalties or licenses from Cedars-Sinai Medical Systems, paid to author and author’s institution; consulting fees from IBA; several patents planned and pending, not related to this field of work, via Cedars-Sinai; vice-president of Society of Nuclear Medicine. D.E.N. Supported by the BHF (grant nos. CH/09/002, RG/16/10/32375, and RE/18/5/34216) and is the recipient of a Well- come Trust Senior Investigator award (no. WT103782AIA); author is a co-applicant and co-author on the RAPID-CTA trial funded by the National Institute for Health (NIH) Research Health Technology Assessment Programme (no. 13/04/108) and the DEMAND-MI study funded by the BHF (FS/16/75/32533). D.D. NIH/National Heart, Lung, and Blood Institute grants (nos. 1R01HL148787-01A1 and 1R01HL151266); software royalties from Cedars-Sinai Medical Center, outside the current work. M.C.W. Supported by the BHF (grant no. FS/ICRF/20/26002); author has given talks for Canon Medical Systems and Siemens Healthineers; member of the board of directors of Society of Cardiovascular Computed Tomography; president-elect of the education committee of the British Society of Cardiovascular Imaging; president-elect of the European Society of Cardiovascular Radiology; Radiology: Cardiothoracic Imaging editorial board member. Funding Information: M.N.M. (no. FS/19/46/34445), E.T. (no. FS/CRTF/20/24086), A.R.C. (no. FS/16/75/32533), N.L.M. (nos. FS/16/14/32023, RG/20/10/34966, RE/18/5/34216), M.C.W. (nos. FS/ICRF/20/26002, FS/11/014, CH/09/002), and D.E.N. (nos. CH/09/002, RG/16/10/32375, RE/18/5/34216) are supported by the British Heart Foundation (BHF). A.B. and R.W. are supported by a clinical research training fellowship (nos. MR/V007254/1 and MR/V007017/1) from the Medical Research Council. D.D. is supported by National Institutes of Health/National Heart, Lung, and Blood Institute grants (nos. 1R01HL148787-01A1 and 1R01HL151266). The Edinburgh Clinical Research Facilities and Edinburgh Imaging facility are supported by the National Health Service Research Scotland through National Health Service Lothian Health Board. The RAPID-CTCA trial was funded by the National Institute for Health Research Health Technology Assessment Programme (no. 13/04/108). The DEMAND-MI study was funded by the BHF (no. FS/16/75/32533). A.R.C. receives additional support from the Academy of Medical Sciences (no. SGL021/1075). Publisher Copyright: © RSNA, 2022.
Keywords: CT Angiography, Ischemia/Infarction, Quantitative CT

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Local EPrints ID: 483093
URI: http://eprints.soton.ac.uk/id/eprint/483093
PURE UUID: 7fff64a5-9f02-499d-a3b0-f8e3e0aba20e
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 23 Oct 2023 16:39
Last modified: 17 Mar 2024 03:02

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Contributors

Author: Mohammed N. Meah
Author: Anda Bularga
Author: Evangelos Tzolos
Author: Andrew R. Chapman
Author: Marwa Daghem
Author: John D. Hung
Author: Justin Chiong
Author: Caelan Taggart
Author: Ryan Wereski
Author: Alasdair Gray
Author: Marc R. Dweck
Author: Carl Roobottom
Author: Nick Curzen ORCID iD
Author: Attila Kardos
Author: Dirk Felmeden
Author: Nicholas L. Mills
Author: Piotr J. Slomka
Author: David E. Newby
Author: Damini Dey
Author: Michelle C. Williams

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