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Published on: August 28, 2018
Incremental prognostic value of coronary computed tomographic angiography high-risk plaque characteristics in newly
Shinichiro Fujimoto1, Takeshi Kondo2, Kazuhisa Takamura2
1Department of Cardiology, Takase Clinic, Takasaki, Japan; Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Insights
Coronary computed tomographic angiography (CTA) plaque features offer incremental prognostic value beyond traditional risk scores. CTA plaque analysis improves cardiac event prediction in symptomatic patients without known coronary artery disease.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- The prognostic significance of coronary computed tomographic angiography (CTA) plaque features remains underexplored.
- Existing risk scores may not fully capture cardiovascular event risk.
Purpose of the Study:
- To assess the incremental prognostic value of CTA-identified high-risk plaques.
- To determine if plaque characteristics improve risk prediction beyond the Framingham risk score (FRS) and luminal obstruction severity.
Main Methods:
- 628 symptomatic patients without known coronary artery disease underwent CTA.
- Patients were followed for cardiac events, including death, myocardial infarction, and unstable angina.
- Cox models and net reclassification indexes evaluated the incremental prognostic value of plaque characteristics.
Main Results:
- Adding the number of diseased vessels to the FRS significantly improved discrimination (c-statistic from 65.8% to 78.6%, p=0.028).
- Further addition of plaque characteristics did not significantly increase discrimination (c-statistic to 80.0%, p=0.812).
- However, plaque characteristics significantly improved model-fitting (p=0.007) and predictive accuracy, with more consistent reclassification of events.
Conclusions:
- CTA plaque characteristics may offer incremental prognostic value.
- These features enhance risk prediction beyond the number of diseased vessels and the FRS.
Background:
The incremental prognostic value of the plaque features in coronary computed tomographic angiography (CTA) has not been well assessed. This study was designed to determine whether CTA high-risk plaques have prognostic value incremental to the Framingham risk score (FRS) and the severity of luminal obstruction.
Methods:
A total of 628 newly symptomatic patients without known coronary artery disease underwent CTA. They were followed for a median of 677 days during which there were 26 cardiac events, including cardiac death, acute myocardial infarction, and hospitalization for unstable angina. Incremental prognostic value of adding plaque characteristics to the number of diseased vessels and the FRS was evaluated using 3 Cox models and net reclassification indexes.
Results:
The discrimination index was significantly increased by adding the number of diseased vessels to the FRS (change in c-statistic from 65.8% to 78.6%, p=0.028) but not significantly by further adding plaque characteristics (change in c-statistic from 78.6% to 80.0%, p=0.812). However, improved model-fitting by adding plaque characteristics into the linear combination with risk score and the number of diseased vessels (p=0.007 from likelihood ratio test) and the lowest value of Akaike's information criteria of that model indicated that plaque characteristics improved both predictive accuracy and discrimination perspective. More subjects reclassified by plaque characteristics were moved to directions consistent with their subsequent cardiac event status than in an inconsistent direction.
Conclusions:
Evaluation of CTA plaque characteristics may provide incremental prognostic value to the number of diseased vessels and the FRS.
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