The time-varying prognostic value of stenosis and plaque burden in coronary artery disease

Conflicting results have been reported on the prognostic value of coronary stenosis grade and plaque burden. We aimed to investigate the time-varying risk for cardiovascular events associated with diameter stenosis (DS%) and plaque burden.

Patients without a documented cardiac history who underwent coronary computed tomography angiography for suspected coronary artery disease were included. The most severe DS% and plaque burden, defined as percentage atheroma volume (PAV), were used for analysis. The primary endpoint was a composite of all-cause mortality and non-fatal myocardial infarction. For analysis, the maximal follow-up time was 8 years. Among 2819 patients [mean age 62 ± 10; 1245 (45%) male], 235 events occurred during a median follow-up of 6.9 years. Cox models including cardiovascular risk factors, DS%, and PAV demonstrated that DS% but not PAV was predictive for short-term events at 1-year follow-up [adjusted hazard ratio (aHR) 1.028, 95% confidence interval (CI) 1.013-1.044 vs. 1.015, 95% CI 0.978-1.053]. In contrast, PAV but not DS% was predictive for long-term events at 8-year follow-up (aHR 1.035, 95% CI 1.021-1.050 vs. 1.005, 95% CI 0.999-1.012). The predictive value of DS% was stronger before than after 1 year of follow-up (aHR <1 year 1.027, 95% CI 1.012-1.042 vs. aHR 1-8 years 1.001, 95% CI 0.994-1.008; P < 0.01 for difference), while the predictive value of PAV did not significantly change (P = 0.12).

Coronary diameter stenosis holds the highest prognostic significance for short-term cardiovascular events, while plaque burden predicts events in the long term.