Progression of whole-heart Atherosclerosis by coronary CT and major adverse cardiovascular events

Rosendael, A.R. van; Lin, F.Y.; Hoogen, I.J. van den; Ma, X.Y.; Gianni, U.; Alawamlh, O.A.; ... ; Chang, H.J. (2021)

Article / Letter to editor

Background: The current study aimed to examine the independent prognostic value of whole-heart atherosclerosis progression by serial coronary computed tomography angiography (CCTA) for major adverse cardiovascular events (MACE). Methods: The multi-center PARADIGM study includes patients undergoing serial CCTA for symptomatic reasons, >2 years apart. Whole-heart atherosclerosis was characterized on a segmental level, with co-registration of baseline and follow-up CCTA, and summed to per-patient level. The independent prognostic significance of atherosclerosis progression for MACE (non-fatal myocardial infarction [MI], death, unplanned coronary revascularization) was examined. Patients experiencing interval MACE were not omitted. Results: The study population comprised 1166 patients (age 60.5 +/- 9.5 years, 54.7% male) who experienced 139 MACE events during 8.2 (IQR 6.2, 9.5) years of follow up (15 death, 5 non-fatal MI, 119 unplanned revascularizations). Whole-heart percent atheroma volume (PAV) increased from 2.32% at baseline to 4.04% at follow-up. Adjusted for baseline PAV, the annualized increase in PAV was independently associated with MACE: OR 1.23 (95% CI 1.08, 1.39) per 1 standard deviation increase, which was consistent in multiple subpopulations. When categorized by composition, only non-calcified plaque progression associated independently with MACE, while calcified plaque did not. Restricting to patients without events before follow-up CCTA, those with future MACE showed an annualized increase in PAV of 0.93% (IQR 0.34, 1.96) vs 0.32% (IQR 0.02, 0.90), P < 0.001. Conclusions: Whole-heart atherosclerosis progression examined by serial CCTA is independently associated with MACE, with a prognostic threshold of 1.0% increase in PAV per year.

• Coronary artery disease
• Plaque progression
• Coronary CTA
• Risk stratification

• All authors: Rosendael, A.R. van; Lin, F.Y.; Hoogen, I.J. van den; Ma, X.Y.; Gianni, U.; Alawamlh, O.A.; Al'Aref, S.J.; Pena, J.M.; Andreini, D.; Budoff, M.J.; Cademartiri, F.; Chinnaiyan, K.; Choi, J.H.; Conte, E.; Marques, H.; Goncalves, P.D.; Gottlieb, I.; Hadamitzky, M.; Leipsic, J.; Maffei, E.; Pontone, G.; Raff, G.L.; Shin, S.; Kim, Y.J.; Lee, B.K.; Chun, E.J.; Sung, J.M.; Lee, S.E.; Han, D.; Berman, D.S.; Virmani, R.; Samady, H.; Stone, P.; Narula, J.; Bax, J.J.; Shaw, L.J.; Min, J.K.; Chang, H.J.
• Date: 2021-07-01
• Journal: Journal of Cardiovascular Computed Tomography
• Volume: 15
• Issue: 4
• Pages: 322 - 330
• DOI: doi:10.1016/j.jcct.2020.12.007