Plaque Characterization by Coronary Computed Tomography Angiography and the Likelihood of Acute Coronary Events in...

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Radiology

Background:

• Coronary computed tomography angiography (CTA) identifies high-risk plaque (HRP) features like positive remodeling and low attenuation, predicting short-term acute coronary syndrome (ACS) risk.
• Understanding mid-term ACS prediction based on CTA-verified plaque characteristics is crucial for patient management.

Purpose of the Study:

• To evaluate the mid-term predictive value of CTA-verified plaque characteristics for acute coronary syndrome (ACS).
• To assess the association between high-risk plaque (HRP), significant stenosis (SS), and plaque progression (PP) with mid-term ACS events.

Main Methods:

• A cohort of 3,158 patients undergoing CTA had HRP and SS (≥70%) evaluated.
• Serial CTA was performed in 449 patients to assess plaque progression (PP).
• Mid-term outcomes, including fatal and nonfatal ACS, were recorded over a mean follow-up of 3.9 years.

Main Results:

• ACS occurred in 2.8% of patients; incidence was higher in HRP+ (16.3%) and SS+ (5.5%) groups compared to HRP- (1.4%) and SS- (2.1%) groups.
• While HRP+ lesions showed higher ACS rates, the absolute number of ACS events from HRP- lesions was similar to HRP+ lesions.
• Plaque progression (PP) was an independent predictor of ACS, with significantly higher rates in PP+ patients (27% with HRP, 10% without HRP) versus PP- patients (0.3%).

Conclusions:

• CTA-verified HRP is an independent predictor of mid-term ACS.
• Despite HRP being a predictor, a substantial number of ACS events originated from non-HRP lesions.
• Plaque progression detected by serial CTA independently predicts ACS, adding crucial prognostic information beyond initial plaque characterization.