Predicting Acute Myocardial Infarction in the Absence of Detectable Atherosclerotic Plaque With Perivascular Coronary Inflammation

Figures

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  Visual Summary. Coronary CTA Showed No Detectable LCx Plaque by Visual Inspection or AI-QCT But Severe Perivascular Inflammation 96 Days Before NSTEMI AI-QCT = artificial intelligence–guided quantitative computed tomography; CTA = computed tomography angiography; FAI = fat attenuation index; HU = Hounsfield unit; LAD = left anterior descending artery; LCx = left circumflex coronary artery; MIP = maximum intensity projection; NSTEMI = non–ST-segment elevation myocardial infarction; PCI = percutaneous coronary intervention; RCA = right coronary artery.

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  Figure 1. Invasive Coronary Angiogram of the Left Coronary Artery During Acute Non–ST-Segment Elevation Myocardial Infarction The red arrow indicates an occluded obtuse marginal branch of the left circumflex coronary artery vessel with TIMI flow grade 0.

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  Figure 2. Percutaneous Intervention of the Culprit TIMI flow grade 3 is restored in the obtuse marginal branch vessel

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  Figure 3. Coronary Computed Tomography Angiography Maximal Intensity Projection of the Left Circumflex Coronary Artery Vessel No coronary plaque was reported by a board-certified radiologist.

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  Figure 4. Cleerly AI Plaque Analysis Nonobstructive coronary plaque was detected by AI in the LAD and RCA vessels, but no plaque was observed in the LCx vessel. No ischemia was detected. The asterisk denotes that an ischemia analysis was performed by Cleerly on this patient. It is an optional analysis for coronary lesions with stenosis severity 40-90%. AI = artificial intelligence; Cx = left circumflex; LAD = left anterior descending artery; LCx = left circumflex coronary artery; LM = left main; OM1 = first obtuse marginal branch; OM2 = second obtuse marginal branch; PAV = percent atheroma volume; PDA = posterior descending artery; PLB = posterolateral branch; RCA = right coronary artery.

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  Figure 5. FAI Score on Original Preinfarction Coronary Computed Tomography Angiography Adjusted for age and sex, the FAI of the LCx vessel is in the 99th percentile, with a 10.2% predicted risk of a fatal cardiac event within the next 8 years if left untreated. FAI = fat attenuation index; HU = Hounsfield unit; LAD = left anterior descending artery; LCx = left circumflex coronary artery; RCA = right coronary artery.