Imaging of Vulnerable Plaques in Coronary Artery Disease by Multidetector Computed Tomography

NCT ID: NCT00482651

Last Updated: 2012-01-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-11-30

Study Completion Date

2012-01-31

Brief Summary

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Atherosclerosis is a chronic and multifocal immunoinflammatory, fibroproliferative disease of medium-sized and large arteries driven by lipid. Atherosclerosis is rarely fatal unless thrombosis supervene, causing an acute coronary syndrome. Therefore, for event-free survival, the vital question is not why atherosclerosis develops but rather why atherosclerosis, after years after indolent growth, suddenly becomes complicated with luminal thrombosis.

The great majority of coronary plaques will remain quiescent, at least from a clinical point of view.

Acute coronary syndrome is primarily precipitated by a ruptured plaque. The precipitating factor or condition may be found outside rather than inside the plaque.

The challenge is to find the plaque(s) destined for the next thrombus-mediated heart attack(s), treat, and thus avoid the heart attack(s). Identification of vulnerable plaques has become a key issue. The natural history of individual plaques (risk of thrombosis) is unknown and needs to be established.

Multidetector computed tomography (MDCT) can provide angiography and imaging of the vessel wall (detection, quantification and characterization of plaques).

The intention of this project is to evaluate the accuracy of coronary MDCT in identifying and differentiating the morphology of coronary atherosclerotic plaques.

Detailed Description

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Atherosclerosis without thrombosis is rarely fatal. It is the acute thrombotic complications which account for disability and death. Therefore, for event-free survival, the question is not why atherosclerosis develops but rather why atherosclerosis, after years after indolent growth, suddenly becomes complicated with luminal thrombosis.

Post-mortem and clinical observations indicate that patients with acute coronary syndromes often have many ruptured and/or active plaques in their coronary arteries.

The challenge is to find the plaque(s) destined for the next thrombus-mediated heart attack(s), treat, and thus avoid the heart attack(s). Identification of vulnerable plaques have become a key issue. The natural history of individual plaques (risk of thrombosis) is unknown and needs to be established. Multidetector computed tomography (MDCT) can provide angiography and imaging of the vessel wall.

Hypothesis:

It is by CT-scanning possible to 1a) identify and differentiate the morphology of coronary atherosclerotic plaques.

1b) identify vulnerable plaques.

Materials and methods:

1. Development of an MDCT scan protocol for accurate assessment of coronary artery plaque composition by ex vivo examination of human coronary arteries from the Institute of Forensic Medicine, University of Aarhus. Scan protocols parameters and intravascular contrast material will be varied to optimize accurate assessment of coronary plaque composition. MDCT will be compared to histopathology.
2. A cross-sectional study with clinical application of the efficiency parameters defined in sub-study 1. Forty consecutive patients with non ST-elevation myocardial infarction/unstable angina, and 80 consecutive patients with stable angina will be recruited and investigated with MDCT followed by CAG with IVUS/virtual histology.
3. A prospective, longitudinal study. After a period of 12 months all patients from sub-study 2 will be re-investigated.
4. Before the cross-sectional study a small pilot-study will be performed. Ten patients with non ST-elevation myocardial infarction/unstable angina will undergo MDCT and CAG with IVUS/virtual histology. These patients will after one months undergo another MDCT. This is done to make sure that it is possible to perform the planned longitudinal study.

Research plan:

1. Development of an MDCT scan protocol for accurate assessment of coronary artery plaque composition.
2. Clinical application of the MDCT scan protocol for in vivo differentiation of coronary artery plaque morphology. Morphologic findings will be categorized and compared with IVUS/virtual histology for confirmation.
3. Re-evaluation of plaque density and morphology one year after inclusion by a second in vivo contrast-enhanced MDCT-scanning to define which morphological plaque categories are at risk of progression.

Conditions

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Atherosclerosis

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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UAP, SAP

Group Type EXPERIMENTAL

Multidetector computed tomography scanning

Intervention Type RADIATION

contrast Multidetector CT-scanning

Coronary angiography (CAG)

Intervention Type PROCEDURE

CAG and if necessary PCI. Included patients are already assigned for CAG

Intravascular ultrasound

Intervention Type PROCEDURE

During CAG Intravascular Ultrasound will be performed in the three coronary arteries

Blood sample

Intervention Type PROCEDURE

a blood sample at baseline after 3 months and at the end of the follow up (after 12 months)

Interventions

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Multidetector computed tomography scanning

contrast Multidetector CT-scanning

Intervention Type RADIATION

Coronary angiography (CAG)

CAG and if necessary PCI. Included patients are already assigned for CAG

Intervention Type PROCEDURE

Intravascular ultrasound

During CAG Intravascular Ultrasound will be performed in the three coronary arteries

Intervention Type PROCEDURE

Blood sample

a blood sample at baseline after 3 months and at the end of the follow up (after 12 months)

Intervention Type PROCEDURE

Other Intervention Names

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Philips Brilliance 64 Volcano / virtual histology

Eligibility Criteria

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Inclusion Criteria

* Unstable angina pectoris Stable angina pectoris

Exclusion Criteria

* known allergy towards the contrast agent not able to hold ones breath for 20 seconds pulmonal, renal or heart failure, cancer, or inflammatory disease arrythmia intolerant to treatment with beta-blockers claustrophobia, pregnancy, breast-feeding previous bypass surgery or PCI continuing breast pain
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Danish Research Agency

OTHER

Sponsor Role collaborator

Philips Medical Systems

INDUSTRY

Sponsor Role collaborator

Danish Heart Foundation

OTHER

Sponsor Role collaborator

University of Aarhus

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Hans Erik Boetker, MD,PhD,DMSc

Role: STUDY_DIRECTOR

Aarhus University Hospital

Locations

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Department of Cardiology, Aarhus University hospital, Skejby

Aarhus N, , Denmark

Site Status

Countries

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Denmark

Other Identifiers

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MDCT2403

Identifier Type: -

Identifier Source: org_study_id

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