Plaque Burden and 1-Year Outcomes in Acute Chest Pain: Results From the Multicenter RAPID-CTCA Trial

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Computed tomography (CT) plaque burden is a known predictor of coronary events in stable chest pain patients.
• The prognostic value of plaque characteristics in acute chest pain requires further investigation.

Purpose of the Study:

• To determine if plaque burden and characteristics predict death or myocardial infarction in patients with acute chest pain.
• To assess the association between coronary CT angiography findings and adverse cardiovascular events.

Main Methods:

• Post hoc analysis of a multicenter trial involving 404 patients with suspected acute coronary syndrome.
• Quantitative plaque analysis using coronary CT angiography.
• Assessment of 1-year all-cause death or nonfatal myocardial infarction as the primary endpoint.
• Comparison with GRACE score and obstructive coronary artery disease.

Main Results:

• Higher plaque burden (total, noncalcified, low-attenuation) was associated with increased risk of primary events.
• Low-attenuation plaque burden was the strongest predictor, outperforming GRACE score and obstructive coronary artery disease.
• Patients with high low-attenuation plaque burden had an 8-fold increased risk of adverse events.

Conclusions:

• Low-attenuation plaque burden is a major predictor of 1-year death or myocardial infarction in patients with suspected acute coronary syndrome.
• CT plaque characteristics provide significant prognostic information beyond traditional risk scores and anatomical stenosis.