We tested the hypothesis that morphologic lesion assessment helps detect
acute coronary syndrome (ACS) during index hospitalization in patients with acute
chest pain and significant
stenosis on coronary computed tomographic angiogram (CTA). Patients who presented to an emergency department with
chest pain but no objective signs of
myocardial ischemia (nondiagnostic electrocardiogram and negative initial
biomarkers) underwent CT angiography. CTA was analyzed for degree and length of
stenosis, plaque area and volume, remodeling index, CT attenuation of plaque, and spotty
calcium in all patients with significant
stenosis (>50% in diameter) on CTA. ACS during index hospitalization was determined by a panel of 2 physicians blinded to results of CT angiography. For lesion characteristics associated with ACS, we determined cutpoints optimized for diagnostic accuracy and created lesion scores. For each score, we determined the odds ratio (OR) and discriminatory capacity for the prediction of ACS. Of the overall population of 368 patients, 34 had significant
stenosis and 21 of those had ACS. Scores A (remodeling index plus spotty
calcium: OR 3.5, 95% confidence interval [CI] 1.2 to 10.1, area under curve [AUC] 0.734), B (remodeling index plus spotty
calcium plus
stenosis length: OR 4.6, 95% CI 1.6 to 13.7, AUC 0.824), and C (remodeling index plus spotty
calcium plus
stenosis length plus plaque volume <90 HU: OR 3.4, 95% CI 1.5 to 7.9, AUC 0.833) were significantly associated with ACS. In conclusion, in patients presenting with acute
chest pain and
stenosis on coronary CTA, a CT-based score incorporating morphologic characteristics of coronary lesions had a good discriminatory value for detection of ACS during index hospitalization.