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Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study.
Int J Cardiovasc Imaging. 2020 12; 36(12):2357-2364.IJ

Abstract

To determine whether the assessment of individual plaques is superior in predicting the progression to obstructive coronary artery disease (CAD) on serial coronary computed tomography angiography (CCTA) than per-patient assessment. From a multinational registry of 2252 patients who underwent serial CCTA at a ≥ 2-year inter-scan interval, patients with only non-obstructive lesions at baseline were enrolled. CCTA was quantitatively analyzed at both the per-patient and per-lesion level. Models predicting the development of an obstructive lesion at follow up using either the per-patient or per-lesion level CCTA measures were constructed and compared. From 1297 patients (mean age 60 ± 9 years, 43% men) enrolled, a total of 3218 non-obstructive lesions were identified at baseline. At follow-up (inter-scan interval: 3.8 ± 1.6 years), 76 lesions (2.4%, 60 patients) became obstructive, defined as > 50% diameter stenosis. The C-statistics of Model 1, adjusted only by clinical risk factors, was 0.684. The addition of per-patient level total plaque volume (PV) and the presence of high-risk plaque (HRP) features to Model 1 improved the C-statistics to 0.825 [95% confidence interval (CI) 0.823-0.827]. When per-lesion level PV and the presence of HRP were added to Model 1, the predictive value of the model improved the C-statistics to 0.895 [95% CI 0.893-0.897]. The model utilizing per-lesion level CCTA measures was superior to the model utilizing per-patient level CCTA measures in predicting the development of an obstructive lesion (p < 0.001). Lesion-level analysis of coronary atherosclerotic plaques with CCTA yielded better predictive power for the development of obstructive CAD than the simple quantification of total coronary atherosclerotic burden at a per-patient level.Clinical Trial Registration: ClinicalTrials.gov NCT0280341.

Authors+Show Affiliations

Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea. Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.Centro Cardiologico Monzino, IRCCS, Milan, Italy.Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA.Cardiovascular Imaging Unit, SDN IRCCS, Naples, Italy.Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.Pusan University Hospital, Busan, South Korea.Seoul National University Bundang Hospital, Seongnam, South Korea.Centro Cardiologico Monzino, IRCCS, Milan, Italy.Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil.Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada.Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy.UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal.UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal.Centro Cardiologico Monzino, IRCCS, Milan, Italy.Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology, CVPath Institute, Gaithersburg, MD, USA.Icahn School of Medicine at Mount Sinai, New York, NY, USA.Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. hjchang@yuhs.ac. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea. hjchang@yuhs.ac.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

32779077

Citation

Lee, Sang-Eun, et al. "Per-lesion Versus Per-patient Analysis of Coronary Artery Disease in Predicting the Development of Obstructive Lesions: the Progression of AtheRosclerotic PlAque DetermIned By Computed TmoGraphic Angiography Imaging (PARADIGM) Study." The International Journal of Cardiovascular Imaging, vol. 36, no. 12, 2020, pp. 2357-2364.
Lee SE, Sung JM, Andreini D, et al. Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study. Int J Cardiovasc Imaging. 2020;36(12):2357-2364.
Lee, S. E., Sung, J. M., Andreini, D., Al-Mallah, M. H., Budoff, M. J., Cademartiri, F., Chinnaiyan, K., Choi, J. H., Chun, E. J., Conte, E., Gottlieb, I., Hadamitzky, M., Kim, Y. J., Lee, B. K., Leipsic, J. A., Maffei, E., Marques, H., de Araújo Gonçalves, P., Pontone, G., ... Chang, H. J. (2020). Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study. The International Journal of Cardiovascular Imaging, 36(12), 2357-2364. https://doi.org/10.1007/s10554-020-01960-z
Lee SE, et al. Per-lesion Versus Per-patient Analysis of Coronary Artery Disease in Predicting the Development of Obstructive Lesions: the Progression of AtheRosclerotic PlAque DetermIned By Computed TmoGraphic Angiography Imaging (PARADIGM) Study. Int J Cardiovasc Imaging. 2020;36(12):2357-2364. PubMed PMID: 32779077.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study. AU - Lee,Sang-Eun, AU - Sung,Ji Min, AU - Andreini,Daniele, AU - Al-Mallah,Mouaz H, AU - Budoff,Matthew J, AU - Cademartiri,Filippo, AU - Chinnaiyan,Kavitha, AU - Choi,Jung Hyun, AU - Chun,Eun Ju, AU - Conte,Edoardo, AU - Gottlieb,Ilan, AU - Hadamitzky,Martin, AU - Kim,Yong Jin, AU - Lee,Byoung Kwon, AU - Leipsic,Jonathon A, AU - Maffei,Erica, AU - Marques,Hugo, AU - de Araújo Gonçalves,Pedro, AU - Pontone,Gianluca, AU - Shin,Sanghoon, AU - Stone,Peter H, AU - Samady,Habib, AU - Virmani,Renu, AU - Narula,Jagat, AU - Berman,Daniel S, AU - Shaw,Leslee J, AU - Bax,Jeroen J, AU - Lin,Fay Y, AU - Min,James K, AU - Chang,Hyuk-Jae, Y1 - 2020/08/10/ PY - 2020/06/22/received PY - 2020/07/30/accepted PY - 2020/8/12/pubmed PY - 2020/8/12/medline PY - 2020/8/12/entrez KW - Coronary artery atherosclerosis KW - Coronary artery disease KW - Coronary computed tomography angiography KW - Statins SP - 2357 EP - 2364 JF - The international journal of cardiovascular imaging JO - Int J Cardiovasc Imaging VL - 36 IS - 12 N2 - To determine whether the assessment of individual plaques is superior in predicting the progression to obstructive coronary artery disease (CAD) on serial coronary computed tomography angiography (CCTA) than per-patient assessment. From a multinational registry of 2252 patients who underwent serial CCTA at a ≥ 2-year inter-scan interval, patients with only non-obstructive lesions at baseline were enrolled. CCTA was quantitatively analyzed at both the per-patient and per-lesion level. Models predicting the development of an obstructive lesion at follow up using either the per-patient or per-lesion level CCTA measures were constructed and compared. From 1297 patients (mean age 60 ± 9 years, 43% men) enrolled, a total of 3218 non-obstructive lesions were identified at baseline. At follow-up (inter-scan interval: 3.8 ± 1.6 years), 76 lesions (2.4%, 60 patients) became obstructive, defined as > 50% diameter stenosis. The C-statistics of Model 1, adjusted only by clinical risk factors, was 0.684. The addition of per-patient level total plaque volume (PV) and the presence of high-risk plaque (HRP) features to Model 1 improved the C-statistics to 0.825 [95% confidence interval (CI) 0.823-0.827]. When per-lesion level PV and the presence of HRP were added to Model 1, the predictive value of the model improved the C-statistics to 0.895 [95% CI 0.893-0.897]. The model utilizing per-lesion level CCTA measures was superior to the model utilizing per-patient level CCTA measures in predicting the development of an obstructive lesion (p < 0.001). Lesion-level analysis of coronary atherosclerotic plaques with CCTA yielded better predictive power for the development of obstructive CAD than the simple quantification of total coronary atherosclerotic burden at a per-patient level.Clinical Trial Registration: ClinicalTrials.gov NCT0280341. SN - 1875-8312 UR - https://www.unboundmedicine.com/medline/citation/32779077/Per_lesion_versus_per_patient_analysis_of_coronary_artery_disease_in_predicting_the_development_of_obstructive_lesions:_the_Progression_of_AtheRosclerotic_PlAque_DetermIned_by_Computed_TmoGraphic_Angiography_Imaging__PARADIGM__study_ L2 - https://doi.org/10.1007/s10554-020-01960-z DB - PRIME DP - Unbound Medicine ER -