Distinguishing Type 1 from Type 2 Myocardial Infarction by Using CT Coronary Angiography

Purpose: To determine whether quantitative plaque characterization by using CT coronary angiography (CTCA) can discriminate be-tween type 1 and type 2 myocardial infarction. Materials and Methods: This was a secondary analysis of two prospective studies (ClinicalTrials.gov registration nos. NCT03338504 [2014-2019] and NCT02284191 [2018-2020]) that performed blinded quantitative plaque analysis on findings from CTCA in par-ticipants with type 1 myocardial infarction, type 2 myocardial infarction, and chest pain without myocardial infarction. Logistic regres-sion analyses were performed to identify predictors of type 1 myocardial infarction. Results: Overall, 155 participants (mean age, 64 years & PLUSMN; 12 [SD]; 114 men) and 36 participants (mean age, 67 years & PLUSMN; 12; 19 men) had type 1 and type 2 myocardial infarction, respectively, and 136 participants (62 years & PLUSMN; 12; 78 men) had chest pain without myocardial infarction. Participants with type 1 myocardial infarction had greater total (median, 44% [IQR: 35%-50%] vs 35% [IQR: 29%-46%]), noncalcified (39% [IQR: 31%-46%] vs 34% [IQR: 29%-40%]), and low-attenuation (4.15% [IQR: 1.88%-5.79%] vs 1.64% [IQR: 0.89%-2.28%]) plaque burdens (P < .05 for all) than those with type 2. Participants with type 2 myocardial infarction had similar low-attenuation plaque burden to those with chest pain without myocardial infarction (P = .4). Low-attenuation plaque was an independent predictor of type 1 myocardial infarction (adjusted odds ratio, 3.44 [95% CI: 1.84, 6.96]; P < .001), with better discrimination than noncalcified plaque burden and maximal area of coronary stenosis (C statistic, 0.75 [95% CI: 0.67, 0.83] vs 0.62 [95% CI: 0.53, 0.71] and 0.61 [95% CI: 0.51, 0.70] respectively; P & LE; .001 for both). Conclusion: Higher low-attenuation coronary plaque burden in patients with type 1 myocardial infarction may help distinguish these patients from those with type 2 myocardial infarction. (C) RSNA, 2022