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Composition of Coronary Atherosclerotic Plaques in
Patients With Acute Myocardial Infarction and Stable
Angina Pectoris Determined by Contrast-Enhanced
Multislice Computed Tomography
Alexander W. Leber,
, Andreas Knez,
, Carl W. White,
, Franz von Ziegler, Olaf Muehling,
, Christoph Becker,
, Gerhard Steinbeck,
, and Peter Boekstegers,
ultislice computed tomography (CT) allows for
noninvasive detection and quantiﬁcation of cor-
Recently, it has been demonstrated
that after the intravenous administration of a contrast
agent, noncalciﬁed plaques can also be detected, and
that the CT attenuation correlates well with the plaque
echogenity of intravascular ultrasound.
has the potential to provide noninvasive information
about coronary plaque composition and total plaque
burden. Currently, multislice CT-derived data on the
composition of coronary lesions in the entire coronary
system in patients with different syndromes of coro-
nary artery disease are still lacking. In the present
study, we examined whether multislice CT allows
determination of differences of plaque burden and
plaque composition in patients with acute myocardial
infarction (AMI) and stable angina pectoris (SAP).
We included 40 patients who were referred to our
institution for coronary angiography because of an AMI
or typical SAP. The AMI group (group I) consisted of 21
patients who had an AMI as their ﬁrst presentation of
coronary artery disease within 14 Ϯ 5 days of a multi-
slice CT scan. All patients had ST-segment elevation
infarction. No patient had prior SAP or evidence of
myocardial ischemia. Systemic thrombolysis was pe-
formed in 18 patients. Three patients were treated with
aspirin and heparin only. At the time of referral to our
institution, all patients were stable and symptom free.
Group II consisted of 19 patients with SAP who were
referred to our hospital for coronary angiography due to
typical SAP. These patients fullﬁlled all of the following
criteria: no history of coronary artery disease; abnormal
functional test for ischemia; duration of symptoms for
Ͼ2 months with no change in intensity and character of
symptoms; and no changes on the electrocardigram
proving myocardial scarring. All contrast-enhanced CT
scans were screened for a myocardial scar. The average
duration of angina in the SAP group was 5 Ϯ 2 months.
Patients with atrial ﬁbrillation, renal insufﬁciency, and an
impaired ejection fraction (Ͻ60%) were excluded from
this study. The study was approved by the local ethics
committee and all patients gave informed consent to the
investigation. The clinical characteristics and parameters
for both groups are given in Table 1.
Catheterization was performed by the transfemoral
From the Department of Cardiology and Institute for Diagnostic Radi-
ology, Klinikum Grosshadern, University of Munich, Munich, Ger-
many; and Division of Cardiology, University of Minnesota, Minneap-
olis, Minnesota. Dr. Leber’s address is: University of Munich, Klinikum
Grosshadern, Medizinische Klinik I, Marchioninistraße 15, 81377
Mu¨nchen, Germany. E-mail: firstname.lastname@example.org.
Manuscript received September 24, 2002; revised manuscript re-
ceived and accepted November 11, 2002.
©2003 by Excerpta Medica, Inc. All rights reserved. 0002-9149/03/$–see front matter
The American Journal of Cardiology Vol. 91 March 15, 2003 doi:10.1016/S0002-9149(02)03411-2