| Objective:To evaluate and identify the culprit plaques in patients with unstable angina. We performed the CTCA, QCA, and OCT imaging anlysis. Comparison of the different modality seems to be urgently needed so as to make their best use of each other's advantage. And we compared the CTCA and OCT characteristics to evaluate the possibility that use CTCA identify the culprit plaques in patients with unstable angina.Mathods:Between Aug 2008 and Feb 2010,2112 patients suspected to have ischemic heart disease underwent CTCA in our hospital.35 pts with ACS underwent CAG and OCT were enrolled to the study. Medical history and clinical examination indicators were collected as normal. The same sections of the same disease-related targets were anlysed by the three mathods. Minimal lumen diameter, plaque proximal and distal reference diameter, minimal lumen area and vessel reference area, plaque volumes, the minimum CT value, remodeling index, Modified DUKE score were detected by CTCA. Minimal lumen diameter, reference lumen diameter, minimal lumen area reference lumen area, and the SYNTAX Score were detected by angiography. Minimal lumen diameter, plaque proximal and distal reference diameter, minimal lumen area and vessel reference area, thinnest thickness of the fibrous cap, thrombosis, fibrous cap tear were detected by OCT. Lipid pool wsa semiquantified by OCT also. The comparison of the different modality were performed. And we compared the CTCA and OCT characteristics to evaluate the possibility that use CTCAidentify the culprit plaques in patients with unstable angina.Resluts:1. The measured minimal lumen diameter is larger(P<0.01) in CTCA compared with angiography, Significant difference were found neither CTCA imaging and OCT nor angiography imaging and OCT. The measured reference lumen diameter is larger (P<0.05) in CTCA compared with either angiography or OCT, No significant difference were found between angiography imaging and OCT (P>0.05). The measured reference lumen area is larger (P<0.05) in CTCA compared with OCT.. No significant difference were found between angiography imaging and OCT (P>0.05). The measured minimal lumen area is larger (P＜0.05) in CTCA compared with OCT. No significant difference were found between angiography imaging and OCT(P>0.05). Positive correlation in CTCA and OCT were found in minimal lumen diameter, reference diameter, minimal lumen area and vessel reference area. None of the present imaging modality is perfect. It seems that CAG, CTCA and OCT makes best combination in evaluating coronary artery. They complement each other. CTCA sees the vessel wall best and OCT sees the intima best. CAG and CTCA are good for evaluating the extent of the coronary artery disease.2. The minimum CT values (68±31HU VS 101±25HU, P=0.000) between culprit lesion and non-culprit lesion group were significantly different, so was CTRI (1.2±0.21 VS 1.05±0.13 P=0.004), minimal fibrous cap thickness (112±72μm VS 153±73μm P=0.051). Incidence of thrombosis was 28.6% VS 5.3% P=0.042 between culprit lesion and non-culprit lesion group, The incidence of fibrous cap tear between the two groups were 42.9% VS 10.5% P=0.033.3. Thinnest fibrous cap thickness and the corresponding cross-section minimal CT value shown a positive correlation, the correlation coefficient:0.627, P=0.000, but had a negative correlation with CTRI, the correlation coefficient:-0.45, P=0.000.4. Thinnest fibrous cap thickness is divided into≤65μm and> 65μm group, There was no difference in the two groups in age, sex, BMI, cholesterol level, triglyceride level, low density lipoprotein levels, creatine kinase, creatine kinase MB. However, significant differences between the two groups in the followed characteristics were found. Minimum CT value (50.7±25.5 vs 78.7±29.8 P =0.006), CT remodeling index (1.34±0.22 vs 1.12±0.15 P=0.0013), Hs-CRP (0.28±0.11 vs 0.2±0.06 P=0.008), fibrous cap tear (78.6% vs 19% P=0.001) and lipid rich plaques (85.7% VS 42.9% P=0.013) so far. The incidence of thrombosis (50% VS 14.3% P=0.053) is close to significant difference between the two groups.5. Stepwise regression analysis showed minimum CT values,CTRI and Hs-CPR are related to the fibrous cap thickness, partial correlation coefficients were 0.64,-0.28 and-0.32 respectively.6. Minimal CT values between dissection occurs with or without groups were 52.33±25.7HU VS 78.65±30.6HU P=0.011, CTRI were 1.30±0.23 VS 1.13±0.16P=0.015, Hs-CRP levels were 0.22±0.09 mg/dl VS 0.194±0.05 mg/dl P=0.009. and minimal fibrous cap thickness was 62±15μm VS 149±20μm. P=0.000.7.Minimal CT values in thrombosis with or without group were 59.6±17.5 HU VS 70.7±34.8 HU P=0.348, CTRI were 1.34±0.26 VS 1.15±0.16, P=0.01, Hs-CRP levels were 0.23±0.09 md/dl VS 0.22±0.1 md/dl P=0.76. minimal fibrous cap thickness was 127±25μm VS 74±10μm. P=0.052.Lipid rich plaque were more common in thrombosis group(90% VS 48% P=0.028).Conclusions:1. CTCA measured plaque minimal CT value is positive related to the minimal fibrous cap thickness, but CTRI is negative correlation to the minimal fibrous cap thickness; Combination of CT minimal value and CT remodeling index may be able to predict plaque fibrous cap thickness; 2. The lower minimum CT value, positive remodeling, thinner fibrous cap, and incidence of thrombosis were more familiar in culprit lesion compared with the non-culprit lesion.3. The minimal fibrous cap thickness mesured by OCT showed a negative correlation with Hs-CPR. The higher Hs-CPR levele may indicates erosion of the fibrous cap.4. Combined with the minimal CT value CTRI and Hs-CPR level may be able to predict dissection of the fibrous cap.5. Thinner fibrous cap thickness, large lipid pool and CTCA positive remodeling in the unstable angina cuprit plaques may in high risk of thrombusis. Combined with coronary angiography, CTCA and OCT imaging may better reveal plaque characteristics.
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