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

Botond-Barna Mátyás

Botond-Barna Mátyás

  • Clinic of Cardiology, Mureș County Emergency Clinical HospitalTârgu Mureș, Romania
  • Doctoral School of “George Emil Palade” University of Medicine, Pharmacy, Science and TechnologyTârgu Mureș, Romania
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Mátyás, Botond-Barna
, 
Emanuel Blîndu

Emanuel Blîndu

  • Clinic of Cardiology, Mureș County Emergency Clinical HospitalTârgu Mureș, Romania
  • Doctoral School of “George Emil Palade” University of Medicine, Pharmacy, Science and TechnologyTârgu Mureș, Romania
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Blîndu, Emanuel
, 
Nóra Rat

Nóra Rat

  • Clinic of Cardiology, Mureș County Emergency Clinical HospitalTârgu Mureș, Romania
  • Department of Cardiology, “George Emil Palade” University of Medicine, Pharmacy, Science and TechnologyTârgu Mureș, Romania
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Rat, Nóra
, 
István Kovács

István Kovács

  • Clinic of Cardiology, Mureș County Emergency Clinical HospitalTârgu Mureș, Romania
  • Department of Cardiology, “George Emil Palade” University of Medicine, Pharmacy, Science and TechnologyTârgu Mureș, Romania
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Kovács, István
, 
Corneliu-Florin Buicu

Corneliu-Florin Buicu

Public Health and Management Department, “George Emil Palade” University of Medicine, Pharmacy, Science and TechnologyTârgu Mureș, Romania
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Buicu, Corneliu-Florin
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Theodora Benedek

Theodora Benedek

  • Clinic of Cardiology, Mureș County Emergency Clinical HospitalTârgu Mureș, Romania
  • Department of Cardiology, “George Emil Palade” University of Medicine, Pharmacy, Science and TechnologyTârgu Mureș, Romania
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Benedek, Theodora
  
09 dic 2023
A Race Against Time: Coronary Computed Tomography Angiography Discovers a Highly Inflamed Plaque in 49-Year-Old Right Before STEMI's Cover Image
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Categoria dell'articolo: Case Report
Pubblicato online: 09 dic 2023
Pagine: 117 - 123
Ricevuto: 21 ott 2023
Accettato: 12 nov 2023
DOI: https://doi.org/10.2478/jce-2023-0018
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© 2024 Botond-Barna Mátyás et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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_

Parameters Normal values Patient's values
White blood cells (× 109/L) 4.5–11 30.48
Platelets (× 109/L) 150–400 486
Hemoglobin (g/dL) 13.8–17.2 15.9
Hematocrit (%) 41–50 47.2
Creatinine (mg/dL) 0.74–1.35 1.29
Urea (mg/dL) 6–24 43.80
Glucose (mg/dL) < 99 201
K+ (mmol/L) 3.6–5.2 6.60
Na+ (mmol/L) 135–145 140
CK (U/L) 55–170 813
Total cholesterol (mg/dL) < 200 209.3
HDL cholesterol (mg/dL) > 60 58.2
LDL cholesterol (mg/dL) < 100 129.7
Triglycerides (mg/dL) < 150 97.5
Uric acid (mg/dL) 3.5–7.2 6.8
AST (GOT) (U/L) 8–33 468
ALT (GPT) (U/L) 4–36 208
aPTT (s) 21–35 117.2
CK-MB (ng/mL) 5–25 125.7
hs-cTnI (μg/L) < 14 4.710
Lingua:
Inglese
Frequenza di pubblicazione:
4 volte all'anno
Argomenti della rivista:
Medicina, Medicina clinica, Medicina interna, Cardiologia, Medicina d'urgenza e medicina di terapia intensiva, Radiologia
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