Home > Journal Club > Journal Club 29 July 2015

Journal Club 29 July 2015

Paper

Plaque Characterization by Coronary Computed Tomography Angiography and the Likelihood of Acute Coronary Events in Mid-Term Follow-Up

Presenter

CB

Summary

BACKGROUND

Coronary computed tomography angiography (CTA)-verified positive remodeling and low attenuation plaques are considered morphological characteristics of high-risk plaque (HRP) and predict short-term risk of acute coronary syndrome (ACS).

OBJECTIVES

This study evaluated whether plaque characteristics by CTA predict mid-term likelihood of ACS.

METHODS

The presence of HRP and significant stenosis (SS) of $70% were evaluated in 3,158 patients undergoing CTA. Serial CTA was performed in 449 patients, and plaque progression (PP) was evaluated. Outcomes (fatal and nonfatal ACS) were recorded during follow-up (mean 3.9 2.4 years).

RESULTS

ACS occurred in 88 (2.8%) patients: 48 (16.3%) of 294 HRP(þ) and 40 (1.4%) of 2,864 HRP() patients. ACS was also significantly more frequent in SS(þ) (36 of 659; 5.5%) than SS() patients (52 of 2,499; 2.1%). HRP(þ)/SS(þ) (19%) and HRP(þ)/SS() (15%) had higher rates of ACS compared with no-plaque patients (0.6%). Although ACS incidence was relatively low in HRP() patients, the cumulative number of patients with ACS developing from HRP() lesions (n¼43) was similar to ACS patients with HRP(þ) lesions (n ¼ 45). In patients with serial CTA, PP also was an independent predictor of ACS, with HRP (27%; p < 0.0001) and without HRP (10%) compared with HRP()/PP() patients (0.3%).

CONCLUSIONS

CTA-verified HRP was an independent predictor of ACS. However, the cumulative number of ACS patients with HRP() was similar to patients with HRP(þ). Additionally, plaque progression detected by serial CTA was an independent predictor of ACS.

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