Coronary CT Value in Quantitative Assessment of Intermediate Stenosis

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Cardiac computed tomography angiography (CCTA) is vital for non-invasive coronary artery evaluation and excluding coronary artery disease (CAD).
• Managing intermediate coronary artery stenosis with non-diagnostic functional tests remains challenging.
• Semi-automated CCTA plaque analysis offers promising tools for stenosis evaluation and identifying high-risk plaque features.

Purpose of the Study:

• To evaluate the impact of intermediate coronary artery lesion features on CAD outcomes.
• To assess the utility of semi-automated CCTA atherosclerotic plaque analysis in risk stratification.
• To investigate the association between plaque morphology and major adverse cardiovascular events (MACE).

Main Methods:

• A single-center, prospective cohort study included 133 patients with low-to-intermediate CAD risk.
• 194 intermediate stenoses (CAD-RADS 3) were analyzed using semi-automated CCTA software.
• Patients were prospectively followed for 2 years to ascertain MACE.

Main Results:

• Higher Agatston scores (total calcium deposits) were significantly associated with MACE (p=0.025).
• A lower coronary artery remodeling index (RI) and larger necrotic core area were observed in the MACE group (p=0.037 and p=0.049, respectively).
• Multivariate analysis identified Agatston score and RI as significant predictors of MACE.

Conclusions:

• Elevated Agatston scores and increased necrotic plaque components are linked to MACE.
• Negatively remodeled plaques, indicative of advanced CAD, are also associated with MACE.
• Agatston score and RI are valuable tools for risk stratification of MACE in patients with intermediate coronary stenosis.