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Published on: January 28, 2020
Prognostic value of coronary plaque composition in symptomatic patients with obstructive coronary artery disease
Emmanuel Gall1,2,3,4, Théo Pezel1,2,3,4,5, Solenn Toupin4,6
1Université Paris-Cité, Department of Cardiology, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010, Paris, France.
Insights
Coronary plaque composition analysis using cardiac CT provides significant prognostic value for major adverse cardiovascular events (MACE) in patients with obstructive coronary artery disease (CAD). This analysis improves risk prediction beyond traditional factors and CAD burden alone.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Interventional Cardiology
- Preventive Cardiology
Background:
- Coronary artery disease (CAD) burden markers are established predictors of cardiovascular events.
- The incremental prognostic value of coronary plaque composition analysis in symptomatic patients with obstructive CAD requires further evaluation.
Purpose of the Study:
- To determine if coronary plaque composition analysis via cardiac CT offers additional prognostic information beyond established CAD burden markers.
- To assess the incremental prognostic value of non-calcified plaque features in predicting major adverse cardiovascular events (MACE).
Main Methods:
- A multicentric registry included 2312 symptomatic patients with obstructive CAD (≥50% stenosis) followed for MACE (cardiovascular death or myocardial infarction).
- Coronary segments were analyzed for stenosis degree and plaque composition (non-calcified, mixed, calcified).
- Multivariable Cox regression models assessed prognostic value, including clinical factors, CAD burden (stenosis extent), and plaque features (non-calcified plaque).
Main Results:
- 319 patients (13.8%) experienced MACE during a median 6.7-year follow-up.
- Proximal stenosis, obstructive CAD extent, and non-calcified plaque segments were independently associated with MACE (p < 0.001).
- Plaque composition analysis significantly improved model discrimination and reclassification (C-statistic +0.03, NRI +28.6%, IDI +5.4%, all p < 0.001).
Conclusions:
- Coronary plaque composition analysis by cardiac CT provides incremental prognostic value for MACE prediction in symptomatic patients with obstructive CAD.
- This analysis enhances risk stratification beyond traditional risk factors and CAD burden, leading to more accurate long-term event prediction.
Objectives:
To determine whether plaque composition analysis defined by cardiac CT can provide incremental prognostic value above coronary artery disease (CAD) burden markers in symptomatic patients with obstructive CAD.
Materials And Methods:
Between 2009 and 2019, a multicentric registry included all consecutive symptomatic patients with obstructive CAD (at least one ≥ 50% stenosis on CCTA) and was followed for major adverse cardiovascular (MACE) defined by cardiovascular death or nonfatal myocardial infarction. Each coronary segment was scored visually for both the degree of stenosis and composition of plaque, which were classified as non-calcified, mixed, or calcified. To assess the prognostic value of each CCTA findings, different multivariable Cox regression models were used: model 1: clinical (traditional risk factors); model 2: model 1 + CAD burden (number of proximal segments with stenosis ≥ 50% + number of vessels with obstructive CAD); and model 3: model 2 + plaques feature (number of segments with non-calcified plaque).
Results:
Of 2312 patients (mean age 70 ± 12 years, 46% men), 319 experienced a MACE (13.8%) (median follow-up: 6.7 years (5.9-9.1)). The number of proximal segments with ≥ 50% stenosis, the number of vessels with obstructive CAD, and the number of segments with non-calcified plaque were all independently associated with MACEs (all p < 0.001). The addition of plaque composition analysis (model 3) showed the best improvement in model discrimination and reclassification (C-statistic improvement = 0.03; net reclassification improvement = 28.6%; integrative discrimination index = 5.4%, all p < 0.001).
Conclusions:
In this population, the analysis of coronary plaque composition had an incremental prognostic value to predict MACEs above a model combining traditional risk factors and CAD burden.
Key Points:
Question Several coronary computed tomography angiography (CCTA) studies have shown the potential interest of plaque composition analysis, which can be further evaluated. Findings In symptomatic patients with obstructive coronary artery disease (CAD), plaque composition analysis had an incremental prognostic value above a model combining traditional risk factors and CAD burden. Clinical relevance In symptomatic patients with obstructive CAD, plaque composition analysis using CCTA has a strong incremental prognostic value above a model combining traditional risk factors and CAD burden, thus translating into a more accurate long-term major adverse cardiovascular event prediction.
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