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Comparative Study
. 2024 Nov 5;13(21):e037258.
doi: 10.1161/JAHA.124.037258. Epub 2024 Oct 29.

Characterizing Nonculprit Lesions and Perivascular Adipose Tissue of Patients Following Acute Myocardial Infarction Using Coronary Computed Tomography Angiography: A Comparative Study

Xiaomeng Wang  1 , Ching H Sia  2   3 , Philip D Adamson  4   5 , Charlotte E Greer  4 , Weimin Huang  6 , Hwee K Lee  7 , Shuang Leng  8   9 , Yan T Loong  8 , Nur A S Raffiee  8 , Swee Y Tan  1   8 , Sock H Tan  3 , Lynette L S Teo  10 , Sung L Wong  8 , Xiaoxun Yang  3 , Min S Yew  11 , Thon H Yong  12 , Liang Zhong  1   8 , Leslee J Shaw  13 , Mark Y Y Chan  2   3 , Derek J Hausenloy  1   14   15   16 , Lohendran Baskaran  8   9   14   17
Affiliations
Comparative Study

Characterizing Nonculprit Lesions and Perivascular Adipose Tissue of Patients Following Acute Myocardial Infarction Using Coronary Computed Tomography Angiography: A Comparative Study

Xiaomeng Wang et al. J Am Heart Assoc. .

Abstract

Background: The comparison of coronary computed tomography angiography plaques and perivascular adipose tissue (PVAT) between patients with acute myocardial infarction (AMI) posttreatment and patients with stable coronary artery disease is poorly understood. Our objective was to evaluate the differences in coronary computed tomography angiography-quantified plaque and PVAT characteristics in patients post-AMI and identify signs of residual inflammation.

Methods and results: We analyzed 205 patients (age, 59.77±9.24 years; 92.20% men) with AMI ≤1 month and matched them with 205 patients with stable coronary artery disease (age, 60.52±10.04 years; 90.24% men) based on age, sex, and cardiovascular risk factors. Coronary computed tomography angiography scans were assessed for nonculprit plaque and vessel characteristics, plaque volumes by composition, high-risk plaques, and PVAT mean attenuation. Both patient groups exhibited similar noncalcified plaque volumes (383.35±313.23 versus 378.63±426.25 mm3, P=0.899). However, multivariable analysis revealed that patients post-AMI had a greater patient-wise noncalcified plaque volume ratio (estimate, 0.089 [95% CI, 0.053-0.125], P<0.001), largely attributed to a higher fibrofatty and necrotic core volume ratio, along with higher peri-lesion PVAT mean attenuation (estimate, 3.968 [95% CI, 2.556-5.379], P<0.001). When adjusted for vessel length, patients post-AMI had more high-risk plaques (estimate, 0.417 [95% CI, 0.298-0.536], P<0.001) per patient.

Conclusions: Patients post-AMI displayed heightened noncalcified plaque components, largely due to fibrofatty and necrotic core content, more high-risk plaques, and increased PVAT mean attenuation on a per-patient level, highlighting the necessity for refined risk assessment in patients with AMI after treatment.

Keywords: acute myocardial infarction; coronary atheroma; coronary computed tomography angiography; high‐risk plaques; residual inflammatory risk.

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Figures

Figure 1
Figure 1. CONSORT (Consolidated Standards of Reporting Trials) diagram for the study.
AMI indicates acute myocardial infarction; CAD, coronary artery disease; and CCTA, coronary computed tomography angiography.
Figure 2
Figure 2. Visual representation of coronary computed tomography angiography plaque quantification.
(A) Longitudinal section of a coronary vessel with color‐coded tissue composition (red: necrotic core, yellow: fibrofatty, green: fibrous, white: calcium); (B) a necrotic core–containing cross‐section of a coronary plaque with color‐coded tissue composition (at the orange bar level of [A]); (C) a calcium‐containing cross‐section of a coronary plaque with color‐coded tissue composition (at the blue bar level of [A]); (D) cross‐section of the perivascular adipose tissue around a coronary plaque with color‐coded attenuation (at the blue bar level of [A]).
Figure 3
Figure 3. Total plaque volume (PV) and total volume of each tissue type for patients post–acute myocardial infarction (AMI; excluding culprit lesions) and patients with stable coronary artery disease (CAD).
(A) Total PV; (B) volume of calcified content; (C) volume of noncalcified content; and (D) volume of necrotic core (NC) content.
Figure 4
Figure 4. The volume ratio of each tissue type for patients post–acute myocardial infarction (AMI; excluding culprit lesions) and patients with stable coronary artery disease (CAD) after normalized to total plaque volume.
(A) Calcified content; (B) noncalcified content; (C) necrotic core (NC) content.
Figure 5
Figure 5. The regression model predicted volume ratio of each tissue type for patients with post–acute myocardial infarction (AMI; excluding culprit lesions) and patients with stable coronary artery disease (CAD) after averaging covariates.
(A) Calcified content; (B) noncalcified content; and (C) necrotic core (NC) content.
Figure 6
Figure 6. The regression model predicted per‐patient high‐risk plaques (HRPs) and high‐risk feature counts after normalized to vessel length.
AMI indicates acute myocardial infarction; CAD, coronary artery disease; LAP, low attenuation plaques; PR, positive remodeling; and SC, spotty calcification.
Figure 7
Figure 7. The regression model predicted peri‐lesion perivascular adipose tissue (PVAT) mean attenuation.
AMI indicates acute myocardial infarction; and CAD, coronary artery disease.
See this image and copyright information in PMC

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