Impact of Non-obstructive left main disease on the progression of coronary artery disease: A PARADIGM substudy
Jonathan R Weir-McCall1, Philipp Blanke1, Stephanie L Sellers2
1St. Paul's Hospital & University of British Columbia, Department of Radiology, Vancouver, British Columbia, Canada.
Insights
Non-obstructive left main (LM) disease indicates a more aggressive coronary artery disease (CAD) phenotype. Patients with LM disease show faster plaque progression and higher prevalence of high-risk plaques, suggesting a need for intensified treatment.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Assessing the natural history of coronary artery disease (CAD) is crucial for effective patient management.
- Non-obstructive left main (LM) disease, defined as <50% stenosis, requires further investigation regarding its impact on CAD progression.
- Serial coronary computed tomography angiography (CTA) offers a valuable tool for evaluating changes in atherosclerotic plaque over time.
Purpose of the Study:
- To investigate the impact of non-obstructive left main (LM) disease on the natural history of coronary artery disease (CAD).
- To analyze plaque volume, composition, and stenosis progression in patients with and without LM disease using serial CTA.
- To determine if non-obstructive LM disease is associated with a more aggressive CAD phenotype.
Main Methods:
- Analysis of serial coronary computed tomography angiography (CTA) scans from the PARADIGM study (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) registry.
- Inclusion criteria: patients with evidence of CAD at baseline, serial CTA at ≥2 year interval, and absence of obstructive left main disease.
- Quantification of plaque volume, composition, diameter stenosis, and high-risk plaque features in coronary arteries and their branches.
Main Results:
- Of 944 patients with CAD, 444 (47%) had non-obstructive LM disease.
- Patients with LM disease exhibited higher baseline plaque volume (194.8 vs. 72.9 mm³, p<0.001) and more high-risk plaque (17.5% vs. 13%, p<0.001).
- LM disease was associated with greater annual progression rates of total plaque volume (26.5 vs. 14.9 mm³/yr, p<0.001) and calcified plaque volume (17 vs. 7 mm³/yr, p<0.001).
Conclusions:
- Non-obstructive left main (LM) disease is linked to accelerated plaque progression and increased prevalence of high-risk plaques throughout the coronary tree.
- The findings suggest that non-obstructive LM disease may serve as a marker for an aggressive CAD phenotype.
- Patients with non-obstructive LM disease might benefit from more intensive therapeutic strategies to manage CAD progression.
Background:
The aim of the study is examine the impact of non-obstructive (<50%stenosis) left main (LM) disease on the natural history of coronary artery disease using serial coronary computed tomography angiography (CTA).
Methods:
CTAs from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) study, a prospective multinational registry of patients who underwent serial CTA at a ≥2 year interval were analyzed. Those without evidence of CAD on their baseline scan were excluded, as were those with obstructive left main disease. Coronary artery vessels and their branches underwent quantification of: plaque volume and composition; diameter stenosis; presence of high-risk plaque.
Results:
Of 944 (62 ± 9 years, 60% male) who had evidence of CAD at baseline, 444 (47%) had LM disease. Those with LM disease had a higher baseline plaque volume (194.8 ± 221mm3 versus 72.9 ± 84.3mm3, p < 0.001) and a higher prevalence of high-risk plaque (17.5% versus 13%, p < 0.001) than those without LM disease. On multivariable general linear model, patients with LM disease had greater annual rates of progression of total (26.5 ± 31.4mm3/yr versus 14.9 ± 20.1mm3/yr, p < 0.001) and calcified plaque volume (17 ± 24mm3/yr versus 7 ± 11mm3/yr, p < 0.001), with no difference in fibrous, fibrofatty or necrotic core plaque components.
Conclusion:
The presence of non-obstructive LM disease is associated with greater rates of plaque progression and a higher prevalence of high-risk plaque throughout the entire coronary artery tree compared to CAD without LM involvement. Our data suggests that non-obstructive LM disease may be a marker for an aggressive phenotype of CAD that may benefit from more intensive treatment strategies.
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