High-Risk Plaques on Coronary Computed Tomography Angiography: Correlation With Optical Coherence Tomography
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Updated: Jul 16, 2025
Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
Daisuke Kinoshita1, Keishi Suzuki1, Eisuke Usui2
1Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
High-risk plaque features on coronary CTA correlate with vulnerable plaque characteristics on OCT. This validates CTA for identifying high-risk plaques and predicting cardiovascular events.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Radiology
Background:
- High-risk plaque (HRP) on coronary computed tomography angiography (CTA) is linked to increased cardiovascular event risk.
- Individual HRP features require validation against high-resolution intravascular imaging like optical coherence tomography (OCT).
Purpose of the Study:
- To correlate high-risk plaque (HRP) features identified on coronary computed tomography angiography (CTA) with detailed plaque characteristics visualized by optical coherence tomography (OCT).
Main Methods:
- Patients undergoing both CTA and OCT before coronary intervention were analyzed.
- HRP was defined by at least two features: positive remodeling, low-attenuation plaque, napkin-ring sign, or spotty calcification.
- Culprit lesions were assessed by OCT, and patients were followed for up to three years.
Main Results:
- All four HRP features on CTA were associated with thin-cap fibroatheroma on OCT.
- Specific HRP features correlated with OCT findings of plaque vulnerability, lipid-rich plaque, macrophages, cholesterol crystals, and microvessels.
- Patients with HRP had a significantly higher incidence of major adverse cardiovascular events (4.7% vs. 0.5%).
Conclusions:
- The four defined high-risk plaque features on CTA are associated with vulnerable plaque characteristics on OCT.
- CTA findings of HRP correlate with intravascularly confirmed plaque vulnerability, supporting its use in risk stratification.
Background:
Although patients with high-risk plaque (HRP) on coronary computed tomography angiography (CTA) are reportedly at increased risk for future cardiovascular events, individual HRP features have not been systematically validated against high-resolution intravascular imaging.
Objectives:
The aim of this study was to correlate HRP features on CTA with plaque characteristics on optical coherence tomography (OCT).
Methods:
Patients who underwent both CTA and OCT before coronary intervention were enrolled. Plaques in culprit vessels identified by CTA were evaluated with the use of OCT at the corresponding sites. HRP was defined as a plaque with at least 2 of the following 4 features: positive remodeling (PR), low-attenuation plaque (LAP), napkin-ring sign (NRS), and spotty calcification (SC). Patients were followed for up to 3 years.
Results:
The study included 448 patients, with a median age of 67 years and of whom 357 (79.7%) were male, and 203 (45.3%) presented with acute coronary syndromes. A total of 1,075 lesions were analyzed. All 4 HRP features were associated with thin-cap fibroatheroma. PR was associated with all OCT features of plaque vulnerability, LAP was associated with lipid-rich plaque, macrophage, and cholesterol crystals, NRS was associated with cholesterol crystals, and SC was associated with microvessels. The cumulative incidence of the composite endpoint (target vessel nontarget lesion revascularization and cardiac death) was significantly higher in patients with HRP than in those without HRP (4.7% vs 0.5%; P = 0.010).
Conclusions:
All 4 HRP features on CTA were associated with features of vulnerability on OCT. (Massachusetts General Hospital and Tsuchiura Kyodo General Hospital Coronary Imaging Collaboration; NCT04523194).
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