Quantification of Coronary Atherosclerosis in the Assessment of Coronary Artery Disease

Sang Eun Lee, Severance Hospital
Ji Min Sung, Severance Hospital
Asim Rizvi, New York Presbyterian Hospital
Fay Y. Lin, New York Presbyterian Hospital
Amit Kumar, New York Presbyterian Hospital
Martin Hadamitzky, Deutsches Herzzentrum München
Yong Jin Kim, Seoul National University Hospital
Edoardo Conte, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato
Daniele Andreini
Gianluca Pontone, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato
Matthew J. Budoff, Los Angeles Biomedical Research Institute
Ilan Gottlieb
Byoung Kwon Lee, Severance Hospital
Eun Ju Chun, Seoul National University Bundang Hospital
Filippo Cademartiri, IRCCS Fondazione SDN
Erica Maffei
Hugo Marques, Hospital da Luz
Jonathon A. Leipsic, The University of British Columbia
Sanghoon Shin, National Health Insurance Service Ilsan Hospital
Jung Hyun Choi, Pusan National University
Kavitha Chinnaiyan, William Beaumont Hospital
Gilbert Raff, William Beaumont Hospital
Renu Virmani, CVPath Institute, Inc.
Habib Samady, Emory University School of Medicine
Peter H. Stone, Brigham and Women's Hospital
Daniel S. Berman, Burns and Allen Research Institute
Jagat Narula, Icahn School of Medicine at Mount Sinai
Leslee J. Shaw, Emory University School of Medicine
Jeroen J. Bax, Leiden University Medical Center - LUMC
James K. Min, New York Presbyterian Hospital
Hyuk Jae Chang, Severance Hospital


© 2018 American Heart Association, Inc. BACKGROUND: Diagnosis of coronary artery disease and management strategies have relied solely on the presence of diameter stenosis ≥50%. We assessed whether direct quantification of plaque burden (PB) and plaque characteristics assessed by coronary computed tomography angiography could provide additional value in terms of predicting rapid plaque progression. METHODS AND RESULTS: From a 13-center, 7-country prospective observational registry, 1345 patients (60.4±9.4 years old; 57.1% male) who underwent repeated coronary computed tomography angiography >2 years apart were enrolled. For conventional angiographic analysis, the presence of stenosis ≥50%, number of vessel involved, segment involvement score, and the presence of high-risk plaque feature were determined. For quantitative analyses, PB and annual change in PB (△PB/y) in the entire coronary tree were assessed. Clinical outcomes (cardiac death, nonfatal myocardial infarction, and coronary revascularization) were recorded. Rapid progressors, defined as a patient with ≥median value of △PB/y (0.33%/y), were older, more frequently male, and had more clinical risk factors than nonrapid progressors (all P<0.05). After risk adjustment, addition of baseline PB improved prediction of rapid progression to each angiographic assessment of coronary artery disease, and the presence of high-risk plaque further improved the predictive performance (all P<0.001). For prediction of adverse outcomes, adding both baseline PB and △PB/y showed best predictive performance (C statistics, 0.763; P<0.001). CONCLUSIONS: Direct quantification of atherosclerotic PB in addition to conventional angiographic assessment of coronary artery disease might be beneficial for improving risk stratification of coronary artery disease. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02803411.