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Comparative effectiveness of coronary artery stenosis and atherosclerotic plaque burden assessment for predicting 30-day revascularization and 2-year major adverse cardiac events.
Int J Cardiovasc Imaging. 2020 Dec; 36(12):2365-2375.IJ

Abstract

PURPOSE

To provide comparative prognostic information of coronary atherosclerotic plaque volume and stenosis assessment in patients with suspected coronary artery disease (CAD).

METHODS

We followed 372 patients with suspected or known CAD enrolled in the CORE320 study for 2 years after baseline 320-detector row cardiac CT scanning and invasive quantitative coronary angiography (QCA). CT images were analyzed for coronary calcium scanning (CACS), semi-automatically derived total percent atheroma volume (PAV), segment stenosis score (SSS), in addition to traditional stenosis assessment (≥ 50%) by CT and QCA for (1) 30-day revascularization and (2) major adverse cardiac events (MACE). Area under the receiver operating characteristic curve (AUC) was used to compare accuracy of risk prediction.

RESULTS

Sixty percent of patients had obstructive CAD by QCA with 23% undergoing 30-day revascularization and 9% experiencing MACE at 2 years. Most late events (20/32) were revascularization procedures. Prediction of 30-day revascularization was modest (AUC range 0.67-0.78) but improved after excluding patients with known CAD (AUC range 0.73-0.86, p < 0.05 for all). Similarly, prediction of MACE improved after excluding patients with known CAD (AUC range 0.58-0.73 vs. 0.63-0.77). CT metrics of atherosclerosis burden performed overall similarly but stenosis assessment was superior for predicting 30-day revascularization.

CONCLUSIONS

Angiographic and coronary atherosclerotic plaque metrics perform only modestly well for predicting 30-day revascularization and 2-year MACE in high risk patients but improve after excluding patients with known CAD. Atherosclerotic plaque metrics did not yield incremental value over stenosis assessment for predicting events that predominantly consisted of revascularization procedures.

CLINICAL TRIAL REGISTRATION

NCT00934037.

Authors+Show Affiliations

Department of Medicine/ Diabetology, Mitsui Memorial Hospital, Tokyo, Japan.Federal University of Paraná, Hospital de Clínicas (CHC-UFPR), Curitiba, Brazil.Quanta Diagnostico Nuclear, Curitiba, Brazil.Department of Radiology, Charité, Berlin, Germany.Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.Department of Medicine, Johns Hopkins University, Baltimore, USA.Department of Radiology, Keio University, Tokyo, Japan.Leiden University Medical Center/Medis Medical Imaging Systems, Leiden, The Netherlands.Department of Medicine, Johns Hopkins University, Baltimore, USA.Department of Medicine, Johns Hopkins University, Baltimore, USA.Department of Medicine, Johns Hopkins University, Baltimore, USA.iDepartment of Radiology, Beth Israel Deaconess Medical Center, Boston, USA.Heart Institute (InCor), University of Sao Paulo, São Paulo, Brazil. Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan.Leiden University Medical Center/Medis Medical Imaging Systems, Leiden, The Netherlands.Department of Medicine, Division of Cardiology, Rigshospitalet, Copenhagen, Denmark.Heart Institute (InCor), University of Sao Paulo, São Paulo, Brazil.Department of Radiology, University of Cincinnati, Cincinnati, USA.Department of Radiology, Brigham and Women's Hosptial, Boston, MA, USA.Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.Department of Medicine, Johns Hopkins University, Baltimore, USA.Department of Medicine, Johns Hopkins University, Baltimore, USA. azadeh1@jhmi.edu. Johns Hopkins Hospital, 600 N. Wolfe Street, Halsted 562, Baltimore, MD, 21287-0409, USA. azadeh1@jhmi.edu.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

32361925

Citation

Kishi, Satoru, et al. "Comparative Effectiveness of Coronary Artery Stenosis and Atherosclerotic Plaque Burden Assessment for Predicting 30-day Revascularization and 2-year Major Adverse Cardiac Events." The International Journal of Cardiovascular Imaging, vol. 36, no. 12, 2020, pp. 2365-2375.
Kishi S, Magalhães TA, Cerci RJ, et al. Comparative effectiveness of coronary artery stenosis and atherosclerotic plaque burden assessment for predicting 30-day revascularization and 2-year major adverse cardiac events. Int J Cardiovasc Imaging. 2020;36(12):2365-2375.
Kishi, S., Magalhães, T. A., Cerci, R. J., Zimmermann, E., Matheson, M. B., Vavere, A., Tanami, Y., Kitslaar, P. H., George, R. T., Brinker, J., Miller, J. M., Clouse, M. E., Lemos, P. A., Niinuma, H., Reiber, J. H. C., Kofoed, K. F., Rochitte, C. E., Rybicki, F. J., Di Carli, M. F., ... Arbab-Zadeh, A. (2020). Comparative effectiveness of coronary artery stenosis and atherosclerotic plaque burden assessment for predicting 30-day revascularization and 2-year major adverse cardiac events. The International Journal of Cardiovascular Imaging, 36(12), 2365-2375. https://doi.org/10.1007/s10554-020-01851-3
Kishi S, et al. Comparative Effectiveness of Coronary Artery Stenosis and Atherosclerotic Plaque Burden Assessment for Predicting 30-day Revascularization and 2-year Major Adverse Cardiac Events. Int J Cardiovasc Imaging. 2020;36(12):2365-2375. PubMed PMID: 32361925.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative effectiveness of coronary artery stenosis and atherosclerotic plaque burden assessment for predicting 30-day revascularization and 2-year major adverse cardiac events. AU - Kishi,Satoru, AU - Magalhães,Tiago A, AU - Cerci,Rodrigo J, AU - Zimmermann,Elke, AU - Matheson,Matthew B, AU - Vavere,Andrea, AU - Tanami,Yutaka, AU - Kitslaar,Pieter H, AU - George,Richard T, AU - Brinker,Jeffrey, AU - Miller,Julie M, AU - Clouse,Melvin E, AU - Lemos,Pedro A, AU - Niinuma,Hiroyuki, AU - Reiber,Johan H C, AU - Kofoed,Klaus F, AU - Rochitte,Carlos E, AU - Rybicki,Frank J, AU - Di Carli,Marcelo F, AU - Cox,Christopher, AU - Lima,Joao A C, AU - Arbab-Zadeh,Armin, Y1 - 2020/05/02/ PY - 2020/03/31/received PY - 2020/04/10/accepted PY - 2020/5/4/pubmed PY - 2020/5/4/medline PY - 2020/5/4/entrez KW - Atherosclerosis KW - Coronary artery disease KW - Coronary heart disease KW - Noninvasive coronary angiography KW - Plaque burden SP - 2365 EP - 2375 JF - The international journal of cardiovascular imaging JO - Int J Cardiovasc Imaging VL - 36 IS - 12 N2 - PURPOSE: To provide comparative prognostic information of coronary atherosclerotic plaque volume and stenosis assessment in patients with suspected coronary artery disease (CAD). METHODS: We followed 372 patients with suspected or known CAD enrolled in the CORE320 study for 2 years after baseline 320-detector row cardiac CT scanning and invasive quantitative coronary angiography (QCA). CT images were analyzed for coronary calcium scanning (CACS), semi-automatically derived total percent atheroma volume (PAV), segment stenosis score (SSS), in addition to traditional stenosis assessment (≥ 50%) by CT and QCA for (1) 30-day revascularization and (2) major adverse cardiac events (MACE). Area under the receiver operating characteristic curve (AUC) was used to compare accuracy of risk prediction. RESULTS: Sixty percent of patients had obstructive CAD by QCA with 23% undergoing 30-day revascularization and 9% experiencing MACE at 2 years. Most late events (20/32) were revascularization procedures. Prediction of 30-day revascularization was modest (AUC range 0.67-0.78) but improved after excluding patients with known CAD (AUC range 0.73-0.86, p < 0.05 for all). Similarly, prediction of MACE improved after excluding patients with known CAD (AUC range 0.58-0.73 vs. 0.63-0.77). CT metrics of atherosclerosis burden performed overall similarly but stenosis assessment was superior for predicting 30-day revascularization. CONCLUSIONS: Angiographic and coronary atherosclerotic plaque metrics perform only modestly well for predicting 30-day revascularization and 2-year MACE in high risk patients but improve after excluding patients with known CAD. Atherosclerotic plaque metrics did not yield incremental value over stenosis assessment for predicting events that predominantly consisted of revascularization procedures. CLINICAL TRIAL REGISTRATION: NCT00934037. SN - 1875-8312 UR - https://www.unboundmedicine.com/medline/citation/32361925/Comparative_effectiveness_of_coronary_artery_stenosis_and_atherosclerotic_plaque_burden_assessment_for_predicting_30_day_revascularization_and_2_year_major_adverse_cardiac_events_ L2 - https://doi.org/10.1007/s10554-020-01851-3 DB - PRIME DP - Unbound Medicine ER -