Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes With CCTA
Dr . Nilay S. Nimbalkar, reviewing Sang-Eun Lee, MD, PHD,a,b,c Ji Min Sung, PHD,a,b Daniele Andreini, MD, PHD,d Mouaz H. Al-Mallah, MD,e Matthew J. Budoff, MD,f Filippo Cademartiri, MD, PHD,g Kavitha Chinnaiyan, MD,h Jung Hyun Choi, MD, PHD,i Eun Ju Chun, MD, PHD,j Edoardo Conte, MD,d Ilan Gottlieb, MD, PHD,k Martin Hadamitzky, MD,l Yong Jin Kim, MD, PHD,m Byoung Kwon Lee, MD, PHD,n Jonathon A. Leipsic, MD,o Erica Maffei, MD,p Hugo Marques, MD, PHD,q Pedro de Araújo Gonçalves, MD, PHD,q Gianluca Pontone, MD, PHD,d Gilbert L. Raff, MD,h Sanghoon Shin, MD,c Peter H. Stone, MD,r Habib Samady, MD,s Renu Virmani, MD,t Jagat Narula, MD, PHD,u Daniel S. Berman, MD,v Leslee J. Shaw, PHD,w Jeroen J. Bax, MD, PHD,x Fay Y. Lin, MD,w James K. Min, MD,w Hyuk-Jae Chang, MD, PHDa,b
Study question : This study explored whether the pattern of progression would differ from nonobstructive lesion and obstructive lesions according to the presence of high-risk plaque features (HRP).
Patients with nonobstructive coronary artery disease, defined as percent diameter stenosis (%DS) <50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an interscan interval of >2 years. HRP was defined as lesions with >2 features of positive remodeling, spotty calcification, or low-attenuation plaque. Quantitative total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions.
Geographic inclusion included South korea, Europe and US.
All coronary arteries and their branches with diameters >2 mm were evaluated; the presence of an atherosclerotic lesion was defined as any tissue >1 mm3 within or adjacent to the lumen that could be discriminated from surrounding structures and identified in >2 planes
For each lesion, %DS, lesion length (mm), plaque volume (mm3), and vessel volume (millimeters cubed) were determined.
HRP was defined as lesions with >2 features of positive remodeling, spotty calcification, or low-attenuation plaque. Quantitative total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions.
A total of 3,049 nonobstructive lesions were identified from 1,297 patients (mean age 60.3 ` 9.3 years; 56.8% men).
There were 2,624 non-HRP and 425 HRP lesions.
HRP lesions had a greater total PAV and all noncalcified components of PAV and %DS at baseline compared with non-HRP lesions. However, the annualized total PAV changes were greater in non-HRP lesions than in HRP lesions.
On multivariate analysis adjusted for clinical risk factors, drug use, change in lipid level, total PAV, %DS, and HRP, only the baseline total PAV and %DS independently predicted the development of obstructive lesions (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02 to 1.07, and HR: 1.07; 95% CI: 1.04 to 1.10, respectively, all p < 0.05), whereas the presence of HRP did not (p > 0.05).
The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP in patients with nonobstructive CAD. Baseline total PAV was the most important predictor of nonobstructive lesions progressing to obstructive lesions, but the presence of HRP was not a factor. Rather than focusing on the qualitative plaque characteristics, a more sophisticated evaluation of quantitative atherosclerotic plaque burden may enhance methods of identifying non-obstructive plaques at higher risk of becoming obstructive lesions. (Progression of Atherosclerotic Plaque Determined By Computed Tomographic Angiography Imaging [PARADIGM];