Characteristics of Culprit Lesion and Changes in Plaque Composition. A Dual Energy Cardiac CT Study

Brief Summary: Identifying patients who are at risk for a future myocardial infarction, is still one of the biggest challenges in cardiology.

In this study the investigators will investigate culprit lesion in patients with NSTEMI and the ability of cardiac CT with dual energy computed tomography (DECT) scanning to describe and identify plaques that may be vulnerable. The investigators will also describe changes in characteristic in both stable and unstable plaques during 1 year follow up of NSTEMI and a matching group of stable angina pectoris (SAP) patients.

Detailed Description: Patients with verified NSTEMI undergo contrast-enhanced coronary DECT before conventional coronary angiography (CAG), and DECT characteristics of the culprit lesion will be determined. All Non-culprit lesions will be observed during 2 month and 1 year follow up characteristics and changes in plaque composition, volume and core content will be assessed.

Patients with SAP undergo a baseline DECT similar to NSTEMI group. Because the expected change in coronary plaques in SAP group is minimal, there is no need for follow up at 2 month.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Not suitable to undergo CT with contrast agent:
Known allergy-like reactions to contrast or Claustrophobia
Atrial fibrillation or significant arrhythmia judged to potentially limit quality of CT
Known renal failure/insufficiency or s-creatinin> 140 µmol/L.
Severe/symptomatic thyrotoxicosis
pacemaker

Arm && Interventions

Group	Intervention	Description
NSTEMI	Cardiac CT	patients hospitalized with NSTEMI diagnosed according to the national Danish guidelines, and are scheduled to coronary angiography.
patients with stable angina pectoris	Cardiac CT	Patients in this group have stable angina symptoms and had verified plaques by earlier CAG or Cardiac CT

Primary Outcome Measures

Name	Time	Method
Description and characteristics of culprit lesion by DECT. (z-value)	72 hours	measure the z-value for the culprit lesion, by marking the culprit lesion with a region of interest (ROI) and the DECT will calculate the mean z-value by mg/mm\^3 in the marked ROI

Secondary Outcome Measures

Name	Time	Method
Measure the volume of the culprit lesion	72 hours	CT software will be automatically able to measure the volume (mm3) og culprit lesion
Determine the mean Z value for non-culprit plaques containing 3: calcified tissue	1 year	z-value mg/mm\^3
z value in myocardium related to culprit vessel compared to z-value in myocardium corresponded to non-culprit vessel	72 hours	z-value z-value mg/mm\^3
Determine the mean Z value for non-culprit plaques containing 1: soft tissue	1 year	measure the z-value for the culprit lesion, by marking the lesion with a ROI and the DECT will calculate the mean z-value mg/mm\^3 in the marked ROI
changes in non-culprit plaques during 1 year in comparison til patients with stable angina pectoris	1 year	z-value z-value mg/mm\^3
Determine the mean Z value for non-culprit plaques containing 2: mixed tissue	1 year	z-value mg/mm\^3
Describe if the culprit lesion contains 1: soft 2: mixed or 3: calcified tissue	72 hours	Visually description if the culprit lesion contain 1: soft tissue (dark area in the scan) 3: calc (white area) or 2: mixed (combined dark and white areas)
Measure the remodeling index of culprit lesion	72 hours	CT software will be automatically able to measure the remodeling index in culprit lesion (mm)

Locations (1): Department of Medical Research, OUH, Svendborg
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Svendborg, Denmark

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