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A Race Against Time: Coronary Computed Tomography Angiography Discovers a Highly Inflamed Plaque in 49-Year-Old Right Before STEMI Cover

A Race Against Time: Coronary Computed Tomography Angiography Discovers a Highly Inflamed Plaque in 49-Year-Old Right Before STEMI

Open Access
|Dec 2023

Figures & Tables

FIGURE 1.

CCTA reveals severe stenosis in the proximal LAD (white arrows), caused by a mixed plaque, which showed clear signs of vulnerability: positive remodeling, low-attenuation plaque, and the napkin-ring sign.
CCTA reveals severe stenosis in the proximal LAD (white arrows), caused by a mixed plaque, which showed clear signs of vulnerability: positive remodeling, low-attenuation plaque, and the napkin-ring sign.

FIGURE 2.

ECG indicating ST-segment elevation in V1–V5
ECG indicating ST-segment elevation in V1–V5

FIGURE 3.

ICA of the target lesion before and after stenting. A – coronary angiography revealing a critical, elongated stenosis in segments I–II of the LAD, characterized by an unstable plaque and overlapping thrombotic material. B, C – angiographic outcomes after revascularization and stenting of the LAD and IB, showing TIMI 3 flow.
ICA of the target lesion before and after stenting. A – coronary angiography revealing a critical, elongated stenosis in segments I–II of the LAD, characterized by an unstable plaque and overlapping thrombotic material. B, C – angiographic outcomes after revascularization and stenting of the LAD and IB, showing TIMI 3 flow.

FIGURE 4.

Analysis of coronary inflammation and calculation of fat attenuation index (FAI) at the level of the culprit lesion. Calculated FAI score was 6.0, which falls in the 91st percentile for coronary inflammation, ranking almost the highest among individuals of the same age and gender.
Analysis of coronary inflammation and calculation of fat attenuation index (FAI) at the level of the culprit lesion. Calculated FAI score was 6.0, which falls in the 91st percentile for coronary inflammation, ranking almost the highest among individuals of the same age and gender.

FIGURE 5.

Syngo.via Frontier® analysis of the mixed plaque at the proximal LAD
Syngo.via Frontier® analysis of the mixed plaque at the proximal LAD

Baseline, risk factors, laboratory and PVAT inflammation parameters for each case_ Increased values are marked with bold_

ParametersNormal valuesPatient's values
White blood cells (× 109/L)4.5–1130.48
Platelets (× 109/L)150–400486
Hemoglobin (g/dL)13.8–17.215.9
Hematocrit (%)41–5047.2
Creatinine (mg/dL)0.74–1.351.29
Urea (mg/dL)6–2443.80
Glucose (mg/dL)< 99201
K+ (mmol/L)3.6–5.26.60
Na+ (mmol/L)135–145140
CK (U/L)55–170813
Total cholesterol (mg/dL)< 200209.3
HDL cholesterol (mg/dL)> 6058.2
LDL cholesterol (mg/dL)< 100129.7
Triglycerides (mg/dL)< 15097.5
Uric acid (mg/dL)3.5–7.26.8
AST (GOT) (U/L)8–33468
ALT (GPT) (U/L)4–36208
aPTT (s)21–35117.2
CK-MB (ng/mL)5–25125.7
hs-cTnI (μg/L)< 144.710
DOI: https://doi.org/10.2478/jce-2023-0018 | Journal eISSN: 2457-5518 | Journal ISSN: 2457-550X
Language: English
Page range: 117 - 123
Submitted on: Oct 21, 2023
Accepted on: Nov 12, 2023
Published on: Dec 9, 2023
Published by: Asociatia Transilvana de Terapie Transvasculara si Transplant KARDIOMED
In partnership with: Paradigm Publishing Services
Publication frequency: 4 times per year

© 2023 Botond-Barna Mátyás, Emanuel Blîndu, Nóra Rat, István Kovács, Corneliu-Florin Buicu, Theodora Benedek, published by Asociatia Transilvana de Terapie Transvasculara si Transplant KARDIOMED
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.