Predicting Acute Myocardial Infarction in the Absence of Detectable Atherosclerotic Plaque With Perivascular Coronary Inflammation.
Authors
Affiliations (2)
Affiliations (2)
- High Desert Heart and Vascular, PLLC, Meridian, Idaho, USA. Electronic address: [email protected].
- High Desert Heart and Vascular, PLLC, Meridian, Idaho, USA.
Abstract
Coronary computed tomography angiography (CTA) with analysis by artificial intelligence (AI) can personalize coronary artery disease risk stratification. A 61-year-old man with coronary artery disease risk factors sought risk stratification admitting to exertional dyspnea. Coronary CTA revealed no plaque in the left circumflex coronary artery (LCx) by visual or AI analysis, but severe perivascular coronary inflammation was measured using the fat attenuation index (FAI) in the 99th percentile for age and gender. He had a non-ST-segment elevation myocardial infarction 96 days later due to occlusion of the LCx obtuse marginal branch. Perivascular coronary inflammation assessed by AI analysis of coronary CTA is predictive of adverse coronary events even in the absence of identifiable coronary plaque. A highly inflamed fatty streak in the coronary endothelium of the LCx capable of acutely occluding the coronary artery was invisible to artificial intelligence-guided quantitative computed tomography, yet left a clear radiomic signature of alarming vascular inflammation described in FAI. Perivascular FAI on coronary CTA can noninvasively personalize the risk of major adverse cardiac events in the absence of detectable coronary plaque.