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Quantification of Coronary Atherosclerosis in the Assessment of Coronary Artery Disease.
Circ Cardiovasc Imaging. 2018 07; 11(7):e007562.CC

Abstract

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.

Authors+Show Affiliations

Division of Cardiology, Severance Cardiovascular Hospital (H.-J.C., S.-E.L., J.M.S.). Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center (H.-J.C., S.-E.L., J.M.S.).Division of Cardiology, Severance Cardiovascular Hospital (H.-J.C., S.-E.L., J.M.S.). Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center (H.-J.C., S.-E.L., J.M.S.).Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (A.K., A.R., F.Y.L., J.K.M.).Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (A.K., A.R., F.Y.L., J.K.M.).Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (A.K., A.R., F.Y.L., J.K.M.).Department of Radiology and Nuclear Medicine, German Heart Center Munich (M.H.).Seoul National University College of Medicine, Seoul National University Hospital, South Korea (Y.-J.K.).Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico Milan, Italy (E.C., G.A., G.P.).No affiliation info availableCentro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico Milan, Italy (E.C., G.A., G.P.).Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.).Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil (I.G.).Gangnam Severance Hospital (B.K.L.), Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.Seoul National University Bundang Hospital, South Korea (E.J.C.).Cardiovascular Imaging Center, SDN Foundation IRCCS, Naples, Italy (F.C.).Department of Radiology, Area Vasta 1/Azienda Sanitaria Unica Regionale Marche Marche, Urbino, Italy (E.M.).Hospital da Luz, Lisbon, Portugal (H.M.).Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, Canada (J.A.L.).National Health Insurance Service Ilsan Hospital, South Korea (S.S.).Busan University Hospital, South Korea (J.H.C.).Department of Cardiology, William Beaumont Hospital, Royal Oak, MI (G.R., K.C.).Department of Cardiology, William Beaumont Hospital, Royal Oak, MI (G.R., K.C.).Department of Pathology, CVPath Institute, Gaithersburg, MD (R.V.).Division of Cardiology, Emory University School of Medicine, Atlanta, GA (H.S., L.J.S.).Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (P.H.S.).Department of Imaging, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.S.B.).Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY (J.N.).Division of Cardiology, Emory University School of Medicine, Atlanta, GA (H.S., L.J.S.).Department of Cardiology, Leiden University Medical Center, The Netherlands (J.J.B.).Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College (A.K., A.R., F.Y.L., J.K.M.).Division of Cardiology, Severance Cardiovascular Hospital (H.-J.C., S.-E.L., J.M.S.) hjchang@yuhs.ac. Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center (H.-J.C., S.-E.L., J.M.S.).

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30012825

Citation

Lee, Sang-Eun, et al. "Quantification of Coronary Atherosclerosis in the Assessment of Coronary Artery Disease." Circulation. Cardiovascular Imaging, vol. 11, no. 7, 2018, pp. e007562.
Lee SE, Sung JM, Rizvi A, et al. Quantification of Coronary Atherosclerosis in the Assessment of Coronary Artery Disease. Circ Cardiovasc Imaging. 2018;11(7):e007562.
Lee, S. E., Sung, J. M., Rizvi, A., Lin, F. Y., Kumar, A., Hadamitzky, M., Kim, Y. J., Conte, E., Andreini, D., Pontone, G., Budoff, M. J., Gottlieb, I., Lee, B. K., Chun, E. J., Cademartiri, F., Maffei, E., Marques, H., Leipsic, J. A., Shin, S., ... Chang, H. J. (2018). Quantification of Coronary Atherosclerosis in the Assessment of Coronary Artery Disease. Circulation. Cardiovascular Imaging, 11(7), e007562. https://doi.org/10.1161/CIRCIMAGING.117.007562
Lee SE, et al. Quantification of Coronary Atherosclerosis in the Assessment of Coronary Artery Disease. Circ Cardiovasc Imaging. 2018;11(7):e007562. PubMed PMID: 30012825.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quantification of Coronary Atherosclerosis in the Assessment of Coronary Artery Disease. AU - Lee,Sang-Eun, AU - Sung,Ji Min, AU - Rizvi,Asim, AU - Lin,Fay Y, AU - Kumar,Amit, AU - Hadamitzky,Martin, AU - Kim,Yong-Jin, AU - Conte,Edoardo, AU - Andreini,Daniele, AU - Pontone,Gianluca, AU - Budoff,Matthew J, AU - Gottlieb,Ilan, AU - Lee,Byoung Kwon, AU - Chun,Eun Ju, AU - Cademartiri,Filippo, AU - Maffei,Erica, AU - Marques,Hugo, AU - Leipsic,Jonathon A, AU - Shin,Sanghoon, AU - Hyun Choi,Jung, AU - Chinnaiyan,Kavitha, AU - Raff,Gilbert, AU - Virmani,Renu, AU - Samady,Habib, AU - Stone,Peter H, AU - Berman,Daniel S, AU - Narula,Jagat, AU - Shaw,Leslee J, AU - Bax,Jeroen J, AU - Min,James K, AU - Chang,Hyuk-Jae, PY - 2018/01/10/received PY - 2018/05/10/accepted PY - 2018/7/18/entrez PY - 2018/7/18/pubmed PY - 2019/8/14/medline KW - angiography KW - atherosclerosis KW - coronary artery disease KW - myocardial infarction KW - risk factors SP - e007562 EP - e007562 JF - Circulation. Cardiovascular imaging JO - Circ Cardiovasc Imaging VL - 11 IS - 7 N2 - 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. SN - 1942-0080 UR - https://www.unboundmedicine.com/medline/citation/30012825/Quantification_of_Coronary_Atherosclerosis_in_the_Assessment_of_Coronary_Artery_Disease_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.117.007562?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -