Progression of non-obstructive coronary plaque: a practical CCTA-based risk score from the PARADIGM registry

Pontone, G.; Rossi, A.; Baggiano, A.; Andreini, D.; Conte, E.; Fusini, L.; ... ; Chang, H.J. (2023)

Article / Letter to editor

Objectives

No clear recommendations are endorsed by the different scientific societies on the clinical use of repeat coronary computed tomography angiography (CCTA) in patients with non-obstructive coronary artery disease (CAD). This study aimed to develop and validate a practical CCTA risk score to predict medium-term disease progression in patients at a low-to-intermediate probability of CAD.

Methods

Patients were part of the Progression of AtheRosclerotic PlAque Determined by Computed Tomographic Angiography Imaging (PARADIGM) registry. Specifically, 370 (derivation cohort) and 219 (validation cohort) patients with two repeat, clinically indicated CCTA scans, non-obstructive CAD, and absence of high-risk plaque (≥ 2 high-risk features) at baseline CCTA were included. Disease progression was defined as the new occurrence of ≥ 50% stenosis and/or high-risk plaque at follow-up CCTA.

Results

In the derivation cohort, 104 (28%) patients experienced disease progression. The median time interval between the two CCTAs was 3.3 years (2.7–4.8). Odds ratios for disease progression derived from multivariable logistic regression were as follows: 4.59 (95% confidence interval: 1.69–12.48) for the number of plaques with spotty calcification, 3.73 (1.46–9.52) for the number of plaques with low attenuation component, 2.71 (1.62–4.50) for 25–49% stenosis severity, 1.47 (1.17–1.84) for the number of bifurcation plaques, and 1.21 (1.02–1.42) for the time between the two CCTAs. The C-statistics of the model were 0.732 (0.676–0.788) and 0.668 (0.583–0.752) in the derivation and validation cohorts, respectively.

Conclusions

The new CCTA-based risk score is a simple and practical tool that can predict mid-term CAD progression in patients with known non-obstructive CAD.

• Computed tomography angiography
• Coronary artery disease
• Disease progression

• All authors: Pontone, G.; Rossi, A.; Baggiano, A.; Andreini, D.; Conte, E.; Fusini, L.; Gebhard, C.; Rabbat, M.G.; Guaricci, A.; Guglielmo, M.; Muscogiuri, G.; Mushtaq, S.; Al-Mallah, M.H.; Berman, D.S.; Budoff, M.J.; Cademartiri, F.; Chinnaiyan, K.; Choi, J.H.; Chun, E.J.; Gonçalves, P.D.; Gottlieb, I.; Hadamitzky, M.; Kim, Y.J.; Lee, B.K.; Lee, S.E.; Maffei, E.; Marques, H.; Samady, H.; Shin, S.; Sung, J.M.; Rosendael, A. van; Virmani, R.; Bax, J.J.; Leipsic, J.A.; Lin, F.Y.; Min, J.K.; Narula, J.; Shaw, L.J.; Chang, H.J.
• Date: 2023-09-26
• Journal: European Radiology
• Volume: 34
• Pages: 2665 - 2676
• DOI: doi:10.1007/s00330-023-09880-x
• Link: https://link.springer.com/article/10.1007/s00330-023-09880-x