Hideya Yamamoto1, Yasuki Kihara2, Toshiro Kitagawa1, Norihiko Ohashi3, Eiji Kunita4, Yoshitaka Iwanaga5, Kazuhiro Kobuke5, Shunichi Miyazaki5, Tomohiro Kawasaki6, Shinichiro Fujimoto7, Hiroyuki Daida7, Takashi Fujii8, Aki Sato9, Tomokazu Okimoto10, Sachio Kuribayashi11. 1. Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8551, Japan. 2. Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8551, Japan. Electronic address: ykihara@hiroshima-u.ac.jp. 3. Department of Internal Medicine, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, 1-9-6 Sendamachi, Naka-ku, Hiroshima, 730-8619, Japan. 4. Division of Cardiology, Kure Kyosai Hospital, 2-3-28 Nishi-chuo, Kure, 737-8508, Japan. 5. Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan. 6. Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume, 830-8577, Japan. 7. Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. 8. Division of Cardiology, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, 738-8503, Japan. 9. Division of Cardiology, Megumino Hospital, 2-3-5 Megumino-nishi, Eniwa, 061-1395, Japan. 10. Department of Cardiology, Tsuchiya General Hospital, 3-30 Nakajimacho, Naka-ku, Hiroshima, 730-8655, Japan. 11. Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Abstract
BACKGROUND: Coronary computed tomography angiography (CCTA) not only provides information regarding luminal stenoses but also allows for visualization of mural atheromatous changes (coronary plaques). OBJECTIVE: We sought to elucidate whether plaques seen on CCTA enable prediction of 2-year outcomes in patients with suspected and known coronary artery disease (CAD). METHODS: Of 3015 patients who underwent CCTA, the images and 2-year clinical courses of 2802 patients were independently analyzed. The primary endpoint was the composite of all-cause death and acute coronary syndrome. RESULTS: During the 2-year observation period, 49 (1.7%) patients developed the primary outcome. The 2-year rates of the primary outcome in the normal (n = 515, no mural lesions), calcium (n = 654, calcified lesion alone), and plaque groups (n = 1633, presence of noncalcified or partially calcified plaques) were 0.2%, 2.0%, and 2.1%, respectively (P = 0.0028). Adverse plaque features such as low attenuation, positive remodeling, spotty calcification, and the napkin-ring sign (low-attenuation core with a higher-attenuation rim) were assessed by an independent core laboratory. Stepwise multivariate Cox proportional hazard analysis showed that a plaque with two or more characteristics (adjusted hazard ratio, 1.98; 95% confidence interval, 1.09-3.60; P = 0.0254), age of ≥67 years (mean), statin treatment after CCTA, and obstructive stenosis remained independent predictors of the primary outcome. CONCLUSIONS: Plaque imaging in CCTA has predictive value for the 2-year outcome and is a useful identifier for high-risk patients among those with known and suspected CAD.
BACKGROUND: Coronary computed tomography angiography (CCTA) not only provides information regarding luminal stenoses but also allows for visualization of mural atheromatous changes (coronary plaques). OBJECTIVE: We sought to elucidate whether plaques seen on CCTA enable prediction of 2-year outcomes in patients with suspected and known coronary artery disease (CAD). METHODS: Of 3015 patients who underwent CCTA, the images and 2-year clinical courses of 2802 patients were independently analyzed. The primary endpoint was the composite of all-cause death and acute coronary syndrome. RESULTS: During the 2-year observation period, 49 (1.7%) patients developed the primary outcome. The 2-year rates of the primary outcome in the normal (n = 515, no mural lesions), calcium (n = 654, calcified lesion alone), and plaque groups (n = 1633, presence of noncalcified or partially calcified plaques) were 0.2%, 2.0%, and 2.1%, respectively (P = 0.0028). Adverse plaque features such as low attenuation, positive remodeling, spottycalcification, and the napkin-ring sign (low-attenuation core with a higher-attenuation rim) were assessed by an independent core laboratory. Stepwise multivariate Cox proportional hazard analysis showed that a plaque with two or more characteristics (adjusted hazard ratio, 1.98; 95% confidence interval, 1.09-3.60; P = 0.0254), age of ≥67 years (mean), statin treatment after CCTA, and obstructive stenosis remained independent predictors of the primary outcome. CONCLUSIONS: Plaque imaging in CCTA has predictive value for the 2-year outcome and is a useful identifier for high-risk patients among those with known and suspected CAD.