Adding coronary computed tomography angiography to invasive coronary angiography improves prediction of cardiac...

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology

Background:

• The prognostic value of computed tomography angiography (CTA) plaque characteristics in patients undergoing invasive coronary angiography (ICA) remains underexplored.
• Current risk stratification relies heavily on luminal diameter narrowing, potentially missing crucial plaque information.

Purpose of the Study:

• To establish the additive value of CTA-derived plaque characteristics beyond traditional stenosis assessment in predicting cardiac events.
• To determine if high-risk plaque (HRP) on CTA improves risk stratification in patients undergoing ICA.

Main Methods:

• A cohort of 676 patients undergoing both ICA and CTA within three months was analyzed.
• Coronary artery segments were assessed for luminal diameter narrowing (ICA) and the presence of HRP (CTA).
• Cardiac events (cardiac death, ACS, revascularization) were tracked for at least three months post-ICA.

Main Results:

• Segments with >25% luminal narrowing showed a higher incidence of coronary events compared to those without (2.94% vs. 0.31%).
• Segments with HRP demonstrated a significantly higher event rate than those without (12.6% vs. 0.46%).
• Both >25% residual luminal narrowing and HRP were independent predictors of cardiac events, with HRP significantly improving predictive models.

Conclusions:

• CTA-derived coronary plaque assessment, particularly HRP detection, enhances the prediction of cardiac events in patients undergoing ICA.
• Integrating CTA plaque characteristics into risk models offers a more comprehensive approach to cardiovascular risk stratification.