Date of Award

2021

Degree Name

Master of Philosophy (School of Medicine)

Schools and Centres

Medicine

First Supervisor

Professor David Playford

Second Supervisor

Professor Carl Schulz

Abstract

Coronary heart disease is the single most frequent cause of mortality in Western countries. Up to 30% of patients surviving an acute coronary syndrome (ACS) will experience a recurrent event within 5 years. Yet precisely defining which of these patients will go on to experience a recurrent event remains difficult despite the use of contemporary risk scores, such as the SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) and GRACE (Global Registry of Acute Coronary Events) scores. Given the important role of computed tomography coronary angiography (CTCA) in defining risk in the low to intermediate risk coronary heart disease cohort, there may be a role for CTCA in better defining risk in higher risk individuals, such as those having suffered ACS. Accurately quantifying total plaque burden and its components (i.e. low attenuation plaque) may provide additional benefit to currently used methods and provide a more accurate measure of risk for these at-risk patients.

This thesis demonstrates that CTCA-derived residual plaque burden and plaque components correlate with risk scores (GRACE and SYNTAX scores) validated as predictors of cardiovascular events and death in individuals following an ACS, providing promising data that suggests CTCA could yet have a role in improving risk stratification in the post-ACS cohort. However, further studies directly comparing CTCA-derived coronary plaque burden with conventional risk stratification models, such as the GRACE and SYNTAX scores, are required to demonstrate any incremental benefit in prognostication for this patient group.

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