OBJECTIVES: The aim of this study was to determine the predictive value of the napkin-ring sign on coronary computed tomography angiography (CTA) for future acute coronary syndrome (ACS) events in patients with coronary artery disease. BACKGROUND: Recent studies have reported a close association between the napkin-ring sign on coronary CTA and thin-cap fibroatheroma. METHODS: The subjects of this prospective study were 895 consecutive patients who underwent coronary CTA examination and were followed for >1 year. The primary endpoint was an ACS event (cardiac death, nonfatal myocardial infarction, or unstable angina pectoris). The coronary CTA analysis included the presence of obstructive plaque, positive remodeling (PR), low-attenuation plaque (LAP), and the napkin-ring sign. The napkin-ring sign was defined by the following criteria: 1) the presence of a ring of high attenuation around certain coronary artery plaques; and 2) attenuation of the ring presenting higher than those of the adjacent plaque and no >130 Hounsfield units. RESULTS: Of the 12,727 segments, 1,174 plaques were observed, including plaques with PR in 130 segments (1.0%), LAP in 107 segments (0.8%), and napkin-ring signs in 45 segments (0.4%). Thirty-six of the 45 plaques with napkin-ring signs (80%) overlapped with those showing either PR or LAP. During the follow-up period (2.3 ± 0.8 years), 24 patients (2.6%) experienced ACS events, and plaques developed in 41% with a napkin-ring sign. Segment-based Cox proportional hazards models analysis showed that PR (p < 0.001), LAP (p = 0.007), and the napkin-ring sign (p < 0.0001) were independent predictive factors for future ACS events. Kaplan-Meier analysis demonstrated that plaques with napkin-ring signs showed a higher risk of ACS events compared with those without a napkin-ring sign. CONCLUSIONS: The present study demonstrated for the first time that the napkin-ring sign demonstrated on coronary CTA was strongly associated with future ACS events, independent of other high-risk coronary CTA features. Detection of the napkin-ring sign could help identify coronary artery disease patients at high risk of future ACS events.
OBJECTIVES: The aim of this study was to determine the predictive value of the napkin-ring sign on coronary computed tomography angiography (CTA) for future acute coronary syndrome (ACS) events in patients with coronary artery disease. BACKGROUND: Recent studies have reported a close association between the napkin-ring sign on coronary CTA and thin-cap fibroatheroma. METHODS: The subjects of this prospective study were 895 consecutive patients who underwent coronary CTA examination and were followed for >1 year. The primary endpoint was an ACS event (cardiac death, nonfatal myocardial infarction, or unstable angina pectoris). The coronary CTA analysis included the presence of obstructive plaque, positive remodeling (PR), low-attenuation plaque (LAP), and the napkin-ring sign. The napkin-ring sign was defined by the following criteria: 1) the presence of a ring of high attenuation around certain coronary artery plaques; and 2) attenuation of the ring presenting higher than those of the adjacent plaque and no >130 Hounsfield units. RESULTS: Of the 12,727 segments, 1,174 plaques were observed, including plaques with PR in 130 segments (1.0%), LAP in 107 segments (0.8%), and napkin-ring signs in 45 segments (0.4%). Thirty-six of the 45 plaques with napkin-ring signs (80%) overlapped with those showing either PR or LAP. During the follow-up period (2.3 ± 0.8 years), 24 patients (2.6%) experienced ACS events, and plaques developed in 41% with a napkin-ring sign. Segment-based Cox proportional hazards models analysis showed that PR (p < 0.001), LAP (p = 0.007), and the napkin-ring sign (p < 0.0001) were independent predictive factors for future ACS events. Kaplan-Meier analysis demonstrated that plaques with napkin-ring signs showed a higher risk of ACS events compared with those without a napkin-ring sign. CONCLUSIONS: The present study demonstrated for the first time that the napkin-ring sign demonstrated on coronary CTA was strongly associated with future ACS events, independent of other high-risk coronary CTA features. Detection of the napkin-ring sign could help identify coronary artery diseasepatients at high risk of future ACS events.
Authors: Hye Rin Kim; Seung Min Yoo; Ji Young Rho; Hwa Yeon Lee; Charles S White Journal: Int J Cardiovasc Imaging Date: 2014-04-01 Impact factor: 2.357
Authors: Hyuk-Jae Chang; Fay Y Lin; Sang-Eun Lee; Daniele Andreini; Jeroen Bax; Filippo Cademartiri; Kavitha Chinnaiyan; Benjamin J W Chow; Edoardo Conte; Ricardo C Cury; Gudrun Feuchtner; Martin Hadamitzky; Yong-Jin Kim; Jonathon Leipsic; Erica Maffei; Hugo Marques; Fabian Plank; Gianluca Pontone; Gilbert L Raff; Alexander R van Rosendael; Todd C Villines; Harald G Weirich; Subhi J Al'Aref; Lohendran Baskaran; Iksung Cho; Ibrahim Danad; Donghee Han; Ran Heo; Ji Hyun Lee; Asim Rivzi; Wijnand J Stuijfzand; Heidi Gransar; Yao Lu; Ji Min Sung; Hyung-Bok Park; Daniel S Berman; Matthew J Budoff; Habib Samady; Leslee J Shaw; Peter H Stone; Renu Virmani; Jagat Narula; James K Min Journal: J Am Coll Cardiol Date: 2018-06-05 Impact factor: 24.094
Authors: Stefan B Puchner; Thomas Mayrhofer; Jakob Park; Michael T Lu; Ting Liu; Pal Maurovich-Horvat; Khristine Ghemigian; Daniel O Bittner; Jerome L Fleg; James E Udelson; Quynh A Truong; Udo Hoffmann; Maros Ferencik Journal: Atherosclerosis Date: 2018-04-17 Impact factor: 5.162