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Evaluation of coronary plaque characteristics with coronary computed tomography angiography in patients with non-obstructive coronary artery disease: a long-term follow-up study.
Eur Heart J Cardiovasc Imaging. 2017 Oct 01; 18(10):1170-1178.EH

Abstract

Aims

Recent studies suggested that even non-obstructive coronary artery disease (CAD) increases major cardiovascular adverse events (MACE) rate. Aim of this study was to evaluate whether coronary computed tomography angiography (CCTA) may detect specific plaque characteristics that may affect prognosis in patients with non-obstructive CAD.

Methods

We enrolled 245 patients who underwent CCTA between April 2004 and April 2007 for suspected CAD and were found to have non-obstructive CAD. Positive remodelling index (PRI), low-attenuation plaque (LAP), plaque burden (PB), spotty calcification (SC), and napkin-ring sign (NRS) have been evaluated for each coronary plaque detected. Acute coronary syndrome, all-cause/cardiac death, and very late elective revascularization (vl-ER) were the endpoints of the study.

Results

A total of 28 events were recorded (2 STEMI, 4 NSTEMI, 6 UA, 2 cardiac deaths, 4 non-cardiac death, and 10 vl-ERs) at long-term follow-up (98 ± 20 months). When adjusted for significant clinical variables PRI > 1.4 (HR 3.31 CI 95% 1.11-9.91, P = 0.0392), LAP (HR 8.45 CI 95% 2.22-32.21, P = 0.0019), PB > 0.7 (HR 5.25 CI 95% 1.45-19.03, P = 0.0120), and NRS (HR 12.52 CI 95% 1.51-103.90, P = 0.0198) were still significantly associated with higher rate of hard cardiac events at follow-up. The Kaplan-Meyer curves confirmed lower cumulative hard cardiac events-free survival in patients presenting at least one coronary plaque with two or more high-risk characteristics when compared with patients with no lesion with more than one high-risk plaque characteristics (log-rank P < 0.0001).

Conclusions

High-risk plaque characteristics at CCTA (PRI > 1.4, PB > 0.7, LAP, and NRS) seem to be promising for risk stratification of patients with non-obstructive CAD.

Authors+Show Affiliations

Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy. Department of Clinical Sciences and Community Health, Cardiovascular Section,University of Milan, Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy. Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy. Department of Clinical Sciences and Community Health, Cardiovascular Section,University of Milan, Milan, Italy.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

27679600

Citation

Conte, Edoardo, et al. "Evaluation of Coronary Plaque Characteristics With Coronary Computed Tomography Angiography in Patients With Non-obstructive Coronary Artery Disease: a Long-term Follow-up Study." European Heart Journal Cardiovascular Imaging, vol. 18, no. 10, 2017, pp. 1170-1178.
Conte E, Annoni A, Pontone G, et al. Evaluation of coronary plaque characteristics with coronary computed tomography angiography in patients with non-obstructive coronary artery disease: a long-term follow-up study. Eur Heart J Cardiovasc Imaging. 2017;18(10):1170-1178.
Conte, E., Annoni, A., Pontone, G., Mushtaq, S., Guglielmo, M., Baggiano, A., Volpato, V., Agalbato, C., Bonomi, A., Veglia, F., Formenti, A., Fiorentini, C., Bartorelli, A. L., Pepi, M., & Andreini, D. (2017). Evaluation of coronary plaque characteristics with coronary computed tomography angiography in patients with non-obstructive coronary artery disease: a long-term follow-up study. European Heart Journal Cardiovascular Imaging, 18(10), 1170-1178. https://doi.org/10.1093/ehjci/jew200
Conte E, et al. Evaluation of Coronary Plaque Characteristics With Coronary Computed Tomography Angiography in Patients With Non-obstructive Coronary Artery Disease: a Long-term Follow-up Study. Eur Heart J Cardiovasc Imaging. 2017 Oct 1;18(10):1170-1178. PubMed PMID: 27679600.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of coronary plaque characteristics with coronary computed tomography angiography in patients with non-obstructive coronary artery disease: a long-term follow-up study. AU - Conte,Edoardo, AU - Annoni,Andrea, AU - Pontone,Gianluca, AU - Mushtaq,Saima, AU - Guglielmo,Marco, AU - Baggiano,Andrea, AU - Volpato,Valentina, AU - Agalbato,Cecilia, AU - Bonomi,Alice, AU - Veglia,Fabrizio, AU - Formenti,Alberto, AU - Fiorentini,Cesare, AU - Bartorelli,Antonio L, AU - Pepi,Mauro, AU - Andreini,Daniele, PY - 2016/05/13/received PY - 2016/08/22/accepted PY - 2016/9/30/pubmed PY - 2018/7/17/medline PY - 2016/9/29/entrez KW - atherosclerosis KW - coronary computed tomography angiography KW - non-obstructive coronary artery disease KW - prevention KW - vulnerable plaque SP - 1170 EP - 1178 JF - European heart journal cardiovascular Imaging JO - Eur Heart J Cardiovasc Imaging VL - 18 IS - 10 N2 - Aims: Recent studies suggested that even non-obstructive coronary artery disease (CAD) increases major cardiovascular adverse events (MACE) rate. Aim of this study was to evaluate whether coronary computed tomography angiography (CCTA) may detect specific plaque characteristics that may affect prognosis in patients with non-obstructive CAD. Methods: We enrolled 245 patients who underwent CCTA between April 2004 and April 2007 for suspected CAD and were found to have non-obstructive CAD. Positive remodelling index (PRI), low-attenuation plaque (LAP), plaque burden (PB), spotty calcification (SC), and napkin-ring sign (NRS) have been evaluated for each coronary plaque detected. Acute coronary syndrome, all-cause/cardiac death, and very late elective revascularization (vl-ER) were the endpoints of the study. Results: A total of 28 events were recorded (2 STEMI, 4 NSTEMI, 6 UA, 2 cardiac deaths, 4 non-cardiac death, and 10 vl-ERs) at long-term follow-up (98 ± 20 months). When adjusted for significant clinical variables PRI > 1.4 (HR 3.31 CI 95% 1.11-9.91, P = 0.0392), LAP (HR 8.45 CI 95% 2.22-32.21, P = 0.0019), PB > 0.7 (HR 5.25 CI 95% 1.45-19.03, P = 0.0120), and NRS (HR 12.52 CI 95% 1.51-103.90, P = 0.0198) were still significantly associated with higher rate of hard cardiac events at follow-up. The Kaplan-Meyer curves confirmed lower cumulative hard cardiac events-free survival in patients presenting at least one coronary plaque with two or more high-risk characteristics when compared with patients with no lesion with more than one high-risk plaque characteristics (log-rank P < 0.0001). Conclusions: High-risk plaque characteristics at CCTA (PRI > 1.4, PB > 0.7, LAP, and NRS) seem to be promising for risk stratification of patients with non-obstructive CAD. SN - 2047-2412 UR - https://www.unboundmedicine.com/medline/citation/27679600/Evaluation_of_coronary_plaque_characteristics_with_coronary_computed_tomography_angiography_in_patients_with_non_obstructive_coronary_artery_disease:_a_long_term_follow_up_study_ L2 - https://academic.oup.com/ehjcimaging/article-lookup/doi/10.1093/ehjci/jew200 DB - PRIME DP - Unbound Medicine ER -