Interplay of CT Coronary Plaque Characteristics and Ischemia to Predict Adverse Outcomes

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Stable coronary artery disease (CAD) management relies on assessing plaque burden and functional significance.
• Current risk stratification may not fully capture combined plaque and hemodynamic information.

Purpose of the Study:

• To investigate the synergistic role of high-risk plaque features on computed tomography (CT) angiography and invasive or non-invasive measures of physiologic stenosis in predicting adverse outcomes in stable CAD patients.

Main Methods:

• Retrospective analysis of 134 patients with stable CAD undergoing CT angiography and assessment of coronary stenosis.
• Coronary CT angiography was analyzed for high-risk plaque features (e.g., low attenuation plaque, positive remodeling, external vascular compression).
• Physiologic stenosis was assessed using fractional flow reserve (FFR) or non-invasive equivalents.

Main Results:

• High-risk plaque features and significant physiologic stenosis independently predicted adverse outcomes.
• A synergistic interaction was observed, where the combination of both factors significantly increased the risk of adverse events compared to either factor alone.
• Patients with both high-risk plaque and significant stenosis had the highest event rates.

Conclusions:

• The combination of high-risk plaque features on CT angiography and significant physiologic stenosis provides a powerful, synergistic approach to risk stratification in stable CAD.
• Integrating imaging-based plaque characteristics with functional stenosis assessment can improve prediction of adverse outcomes.