Comparative effectiveness of coronary artery stenosis and atherosclerotic plaque burden assessment for predicting 30-day revascularization and 2-year major adverse cardiac events

Satoru Kishi, Tiago A. Magalhães, Rodrigo J. Cerci, Elke Zimmermann, Matthew B. Matheson, Andrea Vavere, Yutaka Tanami, Pieter H. Kitslaar, Richard T. George, Jeffrey Brinker, Julie M. Miller, Melvin E. Clouse, Pedro A. Lemos, Hiroyuki Niinuma, Johan H.C. Reiber, Klaus F. Kofoed, Carlos E. Rochitte, Frank J. Rybicki, Marcelo F. Di Carli, Christopher CoxJoao A.C. Lima, Armin Arbab-Zadeh

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To provide comparative prognostic information of coronary atherosclerotic plaque volume and stenosis assessment in patients with suspected coronary artery disease (CAD). Methods: We followed 372 patients with suspected or known CAD enrolled in the CORE320 study for 2 years after baseline 320-detector row cardiac CT scanning and invasive quantitative coronary angiography (QCA). CT images were analyzed for coronary calcium scanning (CACS), semi-automatically derived total percent atheroma volume (PAV), segment stenosis score (SSS), in addition to traditional stenosis assessment (≥ 50%) by CT and QCA for (1) 30-day revascularization and (2) major adverse cardiac events (MACE). Area under the receiver operating characteristic curve (AUC) was used to compare accuracy of risk prediction. Results: Sixty percent of patients had obstructive CAD by QCA with 23% undergoing 30-day revascularization and 9% experiencing MACE at 2 years. Most late events (20/32) were revascularization procedures. Prediction of 30-day revascularization was modest (AUC range 0.67–0.78) but improved after excluding patients with known CAD (AUC range 0.73–0.86, p < 0.05 for all). Similarly, prediction of MACE improved after excluding patients with known CAD (AUC range 0.58–0.73 vs. 0.63–0.77). CT metrics of atherosclerosis burden performed overall similarly but stenosis assessment was superior for predicting 30-day revascularization. Conclusions: Angiographic and coronary atherosclerotic plaque metrics perform only modestly well for predicting 30-day revascularization and 2-year MACE in high risk patients but improve after excluding patients with known CAD. Atherosclerotic plaque metrics did not yield incremental value over stenosis assessment for predicting events that predominantly consisted of revascularization procedures. Clinical Trial Registration: NCT00934037.

Original languageEnglish (US)
Pages (from-to)2365-2375
Number of pages11
JournalInternational Journal of Cardiovascular Imaging
Volume36
Issue number12
DOIs
StatePublished - Dec 2020

Keywords

  • Atherosclerosis
  • Coronary artery disease
  • Coronary heart disease
  • Noninvasive coronary angiography
  • Plaque burden

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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