Novel imaging aspects in the management of patients with acute coronary syndromes

Advances in the treatment of patients with acute coronary syndrome have markedly improved cardiovascular outcomes over the last decades. Although revascularisation and pharmacological therapy are beneficial in terms of morbidity and mortality, still a large number of patients with coronary artery disease (CAD) experiences progression of the disease and/or occurrence of a coronary event. The ability to identify these patients may help to optimize therapy and hence, clinical outcome. Our research focuses on imaging techniques that may assist the identification of patients with CAD at higher risk for recurrent cardiovascular events. Measurement of myocardial perfusion is of prognostic importance. Patients who are treated with percutaneous coronary intervention within the first 5 hours after the onset of symptoms of myocardial infarction have better clinical outcomes. Patients with decreased myocardial perfusion, who have onset of complaints in the early morning hours also have better prognosis. This implicates a 24-hour relationship between myocardial perfusion, myocardial infarct size and clinical outcomes.Computer tomography (CT) angiography has the ability to identify atherosclerosis and its morphology. In patients with myocardial infarction, but without visible atherosclerosis on coronary angiography, CT showed no atherosclerosis in most cases either. It would be reasonable to extend the diagnostic evaluations in these patients. We found correlations between morphological characteristics of atherosclerosis and immune-inflammatory bloodmarkers. These markers are potentially useful in the risk assessment and monitoring of patients with CAD. Normal findings on CT angiography related to early lesions on invasive imaging. Nevertheless, differentiation of advanced plaque may prove difficult in clinical practice.