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The high-risk criteria low-attenuation plaque <60 HU and the napkin-ring sign are the most powerful predictors of MACE: a long-term follow-up study.
Eur Heart J Cardiovasc Imaging. 2017 Jul 01; 18(7):772-779.EH

Abstract

Aims

To assess the prognostic value of coronary CT angiography (CTA) for prediction of major adverse cardiac events (MACE) over a long-term follow-up period.

Methods and Results

A total of 1469 low-to-intermediate-risk patients (65.9 years; 44.2% females) were included in our prospective cohort study. CTA was evaluated for (i) stenosis severity (minimal <10%; mild <50%; moderate 50-70%; severe >70%), (ii) plaque types (calcified, mixed dominantly calcified, mixed dominantly non-calcified, non-calcified), and (iii) high-risk plaque criteria [low-attenuation plaque (LAP) quantified by HU, napkin-ring (NR) sign, spotty calcification <3 mm, and remodelling index (RI)]. Over a follow-up of mean 7.8 years, MACE rate was 41 (2.8%) and 0% in patients with negative CTA. MACE rate increased along with stenosis severity by CTA (from 1.3 to 7.8%) (P < 0.001) and was higher in T3/T4 plaques than in T2/T1 (7.8 vs. 1.9%; P < 0.0001). LAP density was lower (35.2 HU ± 32 vs. 108.8 HU ± 53) (P < 0.001) and both NR-sign prevalence with n = 26 (63.4%) vs. n = 40 (28%) and LAP <30, <60, and <90 HU prevalence with 46.3-78% vs. 2.4-7% were higher in the MACE group (P < 0.001). On univariate and unadjusted multivariable proportional Hazards model, LAP <60 HU and NR were the strongest MACE predictors (HR 4.96; 95% CI: 2.0-12.2 and HR 3.85; 95% CI: 1.7-8.6) (P < 0.0001), while spotty calcification (HR 2.2; 95% CI: 1.1-4.3, P < 0.001), stenosis severity, and plaque type (HR 1.5; 95% CI: 1.1-2.3 and HR 1.7; 95% CI: 1.1-2.6) (P < 0.001) were less powerful. After adjusting for risk factors, CTA stenosis severity, and plaque type, LAP <60 HU and the NR sign remained significant (P < 0.001), while the effect of NR sign was even enhancing. HRP criteria were independent predictors from other risk factors.

Conclusion

Prognosis is excellent over a long-term period if CTA is negative and worsening with an increasing non-calcifying plaque component. LAP <60 HU and NR sign are the most powerful MACE predictors.

Authors+Show Affiliations

Department of Radiology, Innsbruck Medical University,Anichstr. 35, A-6020 Innsbruck, Austria.Department of Radiology, Innsbruck Medical University,Anichstr. 35, A-6020 Innsbruck, Austria.Department of Radiology, Innsbruck Medical University,Anichstr. 35, A-6020 Innsbruck, Austria.Department of Internal Medicine III-Cardiology, Innsbruck Medical University, Innsbruck, Austria.Department of Internal Medicine III-Cardiology, Innsbruck Medical University, Innsbruck, Austria.Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria.Department of Radiology, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria. Department of Internal Medicine III-Cardiology, Innsbruck Medical University, Innsbruck, Austria.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27502292

Citation

Feuchtner, Gudrun, et al. "The High-risk Criteria Low-attenuation Plaque <60 HU and the Napkin-ring Sign Are the Most Powerful Predictors of MACE: a Long-term Follow-up Study." European Heart Journal Cardiovascular Imaging, vol. 18, no. 7, 2017, pp. 772-779.
Feuchtner G, Kerber J, Burghard P, et al. The high-risk criteria low-attenuation plaque <60 HU and the napkin-ring sign are the most powerful predictors of MACE: a long-term follow-up study. Eur Heart J Cardiovasc Imaging. 2017;18(7):772-779.
Feuchtner, G., Kerber, J., Burghard, P., Dichtl, W., Friedrich, G., Bonaros, N., & Plank, F. (2017). The high-risk criteria low-attenuation plaque <60 HU and the napkin-ring sign are the most powerful predictors of MACE: a long-term follow-up study. European Heart Journal Cardiovascular Imaging, 18(7), 772-779. https://doi.org/10.1093/ehjci/jew167
Feuchtner G, et al. The High-risk Criteria Low-attenuation Plaque <60 HU and the Napkin-ring Sign Are the Most Powerful Predictors of MACE: a Long-term Follow-up Study. Eur Heart J Cardiovasc Imaging. 2017 Jul 1;18(7):772-779. PubMed PMID: 27502292.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The high-risk criteria low-attenuation plaque <60 HU and the napkin-ring sign are the most powerful predictors of MACE: a long-term follow-up study. AU - Feuchtner,Gudrun, AU - Kerber,Johannes, AU - Burghard,Philipp, AU - Dichtl,Wolfgang, AU - Friedrich,Guy, AU - Bonaros,Nikolaos, AU - Plank,Fabian, PY - 2016/04/20/received PY - 2016/07/16/accepted PY - 2016/8/10/pubmed PY - 2018/6/15/medline PY - 2016/8/10/entrez KW - atherosclerosis KW - computed tomography KW - coronary artery disease KW - high-risk plaque KW - major adverse cardiac events (MACE) SP - 772 EP - 779 JF - European heart journal cardiovascular Imaging JO - Eur Heart J Cardiovasc Imaging VL - 18 IS - 7 N2 - Aims: To assess the prognostic value of coronary CT angiography (CTA) for prediction of major adverse cardiac events (MACE) over a long-term follow-up period. Methods and Results: A total of 1469 low-to-intermediate-risk patients (65.9 years; 44.2% females) were included in our prospective cohort study. CTA was evaluated for (i) stenosis severity (minimal <10%; mild <50%; moderate 50-70%; severe >70%), (ii) plaque types (calcified, mixed dominantly calcified, mixed dominantly non-calcified, non-calcified), and (iii) high-risk plaque criteria [low-attenuation plaque (LAP) quantified by HU, napkin-ring (NR) sign, spotty calcification <3 mm, and remodelling index (RI)]. Over a follow-up of mean 7.8 years, MACE rate was 41 (2.8%) and 0% in patients with negative CTA. MACE rate increased along with stenosis severity by CTA (from 1.3 to 7.8%) (P < 0.001) and was higher in T3/T4 plaques than in T2/T1 (7.8 vs. 1.9%; P < 0.0001). LAP density was lower (35.2 HU ± 32 vs. 108.8 HU ± 53) (P < 0.001) and both NR-sign prevalence with n = 26 (63.4%) vs. n = 40 (28%) and LAP <30, <60, and <90 HU prevalence with 46.3-78% vs. 2.4-7% were higher in the MACE group (P < 0.001). On univariate and unadjusted multivariable proportional Hazards model, LAP <60 HU and NR were the strongest MACE predictors (HR 4.96; 95% CI: 2.0-12.2 and HR 3.85; 95% CI: 1.7-8.6) (P < 0.0001), while spotty calcification (HR 2.2; 95% CI: 1.1-4.3, P < 0.001), stenosis severity, and plaque type (HR 1.5; 95% CI: 1.1-2.3 and HR 1.7; 95% CI: 1.1-2.6) (P < 0.001) were less powerful. After adjusting for risk factors, CTA stenosis severity, and plaque type, LAP <60 HU and the NR sign remained significant (P < 0.001), while the effect of NR sign was even enhancing. HRP criteria were independent predictors from other risk factors. Conclusion: Prognosis is excellent over a long-term period if CTA is negative and worsening with an increasing non-calcifying plaque component. LAP <60 HU and NR sign are the most powerful MACE predictors. SN - 2047-2412 UR - https://www.unboundmedicine.com/medline/citation/27502292/The_high_risk_criteria_low_attenuation_plaque_<60_HU_and_the_napkin_ring_sign_are_the_most_powerful_predictors_of_MACE:_a_long_term_follow_up_study_ L2 - https://academic.oup.com/ehjcimaging/article-lookup/doi/10.1093/ehjci/jew167 DB - PRIME DP - Unbound Medicine ER -