Related Experiment Video
Updated: Jan 30, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary Artery Plaque Characteristics Associated With Adverse Outcomes in the SCOT-HEART Study
Michelle C Williams1, Alastair J Moss2, Marc Dweck1
1University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, United Kingdom.
Insights
Adverse coronary plaque features identified by coronary computed tomography angiography significantly increase the risk of coronary heart disease events. This highlights the prognostic value of plaque characterization in patients with suspected coronary artery disease.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Preventive Cardiology
Background:
- Coronary computed tomography angiography (CCTA) offers advanced capabilities in characterizing atherosclerotic plaque subtypes, unlike many other noninvasive imaging methods.
- Understanding the prognostic implications of specific plaque characteristics is crucial for risk stratification in patients with suspected coronary artery disease.
Purpose of the Study:
- To investigate the prognostic significance of adverse coronary plaque characteristics in patients suspected of having coronary artery disease.
- To assess the association between plaque features, obstructive disease, and coronary artery calcification with cardiovascular events.
Main Methods:
- A post hoc analysis of the SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) involving 1,769 patients followed for 5 years.
- Coronary computed tomography angiography was used to assess adverse plaque (positive remodeling, low attenuation), obstructive disease, and coronary artery calcification in 15 coronary segments.
- Outcomes included coronary heart disease death or nonfatal myocardial infarction.
Main Results:
- Patients with adverse plaque features (34%) had a 3-fold higher risk of coronary heart disease death or nonfatal myocardial infarction compared to those without.
- Obstructive disease was associated with a 2-fold increased risk of these events.
- The highest event rate (10-fold increase) was observed in patients with both obstructive disease and adverse plaque, though associations were not independent of coronary artery calcium score.
Conclusions:
- Adverse coronary plaque characteristics and overall calcified plaque burden are significant indicators of increased risk for coronary heart disease death or nonfatal myocardial infarction.
- CCTA-derived plaque characterization provides valuable prognostic information beyond traditional risk factors and calcification assessment.
Background:
Unlike most noninvasive imaging modalities, coronary computed tomography angiography can characterize subtypes of atherosclerotic plaque.
Objectives:
The purpose of this study was to investigate the prognostic implications of adverse coronary plaque characteristics in patients with suspected coronary artery disease.
Methods:
In this SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) post hoc analysis, the presence of adverse plaque (positive remodeling or low attenuation plaque), obstructive disease, and coronary artery calcification within 15 coronary segments was assessed on coronary computed tomography angiography of 1,769 patients who were followed-up for 5 years.
Results:
Among study participants (mean age 58 ± 10 years; 56% male), 608 (34%) patients had 1 or more adverse plaque features. Coronary heart disease death or nonfatal myocardial infarction was 3 times more frequent in patients with adverse plaque (n = 25 of 608 [4.1%] vs. n = 16 of 1,161 [1.4%]; p < 0.001; hazard ratio [HR]: 3.01; 95% confidence interval (CI): 1.61 to 5.63; p = 0.001) and was twice as frequent in those with obstructive disease (n = 22 of 452 [4.9%] vs. n = 16 of 671 [2.4%]; p = 0.024; HR: 1.99; 95% CI: 1.05 to 3.79; p = 0.036). Patients with both obstructive disease and adverse plaque had the highest event rate, with a 10-fold increase in coronary heart disease death or nonfatal myocardial infarction compared with patients with normal coronary arteries (HR: 11.50; 95% CI: 3.39 to 39.04; p < 0.001). However, these associations were not independent of coronary artery calcium score, a surrogate measure of coronary plaque burden.
Conclusions:
Adverse coronary plaque characteristics and overall calcified plaque burden confer an increased risk of coronary heart disease death or nonfatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).
More Related Videos
13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
Published on: April 24, 2017
06:25Author Spotlight: Innovative Technique for Coronary Angiography in Marginal Donors
Published on: July 12, 2024
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:27Coronary Artery Disease V: Interprofessional Care
01:27Anatomy of the Heart
01:30Coronary Artery Disease III: Clinical Manifestations
01:26Coronary Artery Disease IV: Preventive Measures