BACKGROUND Coronary atherosclerosis is a chronic inflammatory disease which progresses to luminal stenosis and plaque rupture events. Recent developments in non-invasive cardiovascular imaging have enabled the identification of coronary plaques with an increased propensity to rupture. Coronary computed tomography angiography allows visualisation of thearterial wall to discern regions of high-risk plaque in patients with non-obstructive and obstructive coronary artery disease. The anatomical

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... ssment afforded by coronary computed tomography angiography can be combined with hybrid positron emission tomography computed tomography to provide a measure of disease activity. Using novel radiotracers targeted at specific cellular pathways in atherosclerosis, it is now possible to observe plaque activitywith 18F-sodium fluoride in vivo. The principal aims of this thesis were to evaluate the prognostic impact of adverse plaque features using standard coronary computed tomography angiography,to perform reproducibility and histological validation studies ofa novel non-invasive imaging technique for detecting high-risk plaquewith coronary 18F-fluoride imagingand assess whether coronary 18F-fluoride could be used to select high-risk individuals as part a phase 3 clinical trial of an investigational medicinal product. ADVERSE CORONARY ARTERY PLAQUE CHARACTERISTICS IN PATIENTS WITH CORONARY ARTERY DISEASEIn a prognostic substudy of the SCOT-HEART trial, adverse plaque features were associated with a three-fold increase in coronary heart disease death or non-fatal myocardial infarction (hazard ratio 3.01 (95% confidence intervals 1.61 to 5.63); p=0.001). Patients with both obstructive disease and adverse plaque had the highest event rate with a greater than 10-fold increase in events (hazard ratio 11.50 (95% confidence interval 3.39 to 39.04); p<0.001). However, these associations weredependent coronary artery calcium score, a surrogate measureof coronary plaque burden.MOLECULAR CORONARY PLAQUE IMAGING USING 18F-FLUORIDE To [...]