The Composition and Extent of Coronary Artery Plaque Detected By Multislice Computed Tomographic Angiography Provides Incremental Prognostic Value in Patients With Suspected Coronary Artery Disease

OBJECTIVES: Multislice computed tomographic coronary angiography (CTCA) provides accurate noninvasive assessment of coronary artery disease (CAD). However, data on the prognostic value of CTCA in patients with suspected CAD are only beginning to emerge. The aim of the study was to assess the prognostic value of CTCA in patients with suspected CAD.

METHODS: Patients (males = 259, females = 235; mean age 58.2 ± 9.8 years) with suspected CAD who underwent 16- or 64-slice

CTCA were followed for 1,308 ± 318 days for cardiac death, nonfatal myocaridal infarction (MI) and late (>90 days after CTCA) revascularization. Patient outcomes were related to clinical and CTCA data. Cox proportional-hazards model was applied in stepwise forward fashion to identify outcome predictors.

RESULTS: Coronary artery plaque was found in 340 patients. Cardiac events occurred in 40 patients including cardiac death (n = 9), nonfatal MI (n = 8) and late revascularization (n = 23). A multivariable analysis identified the following independent predictors for adverse cardiac events: obstructive plaque in a proximal coronary artery segment (hazard ratio (HR) 2.73; 95% confidence interval (CI): 1.35-5.54; P = 0.005), the number of segments with noncalcified plaque(s) (HR 1.53 per segment; 95%CI: 1.21-1.92; P < 0.001), the number of segments with mixed plaque(s) (HR 1.56 per segment; 95%CI: 1.27-1.92; P < 0.001) and the number of segments with calcified plaque(s) (HR 1.21 per segment; 95%CI: 1.07-1.37; P = 0.002).

CONCLUSIONS: In patients with suspected CAD, both the extent and composition of atherosclerotic plaque as determined by CTCA are prognostic of subsequent cardiac events.

PMID: 21369735

Posted in Computed Tomography and tagged , , , , , , .

5 Comments

  1. See also:
    Features of Disrupted Plaques by Coronary CT Angiography: Correlates with Invasively-Proven Complex Lesions.
    Madder RD, Chinnaiyan KM, Marandici AM, Goldstein JA.
    Circ Cardiovasc Imaging. 2011 Jan 24. [Epub ahead of print]
    PMID: 21262981

    AND post from December 27th (link):

    Prognostic Value of Cardiac Computed Tomography Angiography A Systematic Review and Meta-Analysis.
    Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC.
    J Am Coll Cardiol. 2010; 57(1):34-35.
    PMID: 21145688

  2. You have to watch out for these studies that use revascularization as an endpoint. Even if it’s greater than 30 days, the decision to revascularize is influenced by the CTA results.

  3. Yes, but revascularization >90 days is an accepted endpoint in this context.

  4. We are aware that the decision to revascularize may be influenced by CTA findings. That is why we have used only late (>90 days) revascularizations, which are frequently considered as endpoints in studies with relatively low number of adverse events. However, we would like to stress that in our study we have also performed multivariable Cox analysis for hard events, which confirmed our results for all events. Interestingly, we have found that noncalcified, mixed and calcified coronary artery plaque burden are independent risk factors for cardiac death and nonfatal myocardial infarction. The data are not provided in the abstract and we cordially invite interested readers to our article.

  5. I personally thought the study was well designed. I have no issues with the late re-vascularization end-point, especially since the enrolled patients were suspected of having CAD… after all about a third of them had a high PRE-test likelihood of having disease! Not necessarily your usual CTA population.

    The findings are in keeping with those from the study by Hadamitzky et al (link) where CCTA improved prediction of cardiac events over and above conventional risk scores.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>