Abstract 12495: Plaque Progression Detected by Serial Coronary Computed Tomography Angiography Predicts Acute Coronary Syndromes
Introduction: Acute coronary syndromes (ACS) have been reported to occur at the mild to moderate stenotic lesions. However, the natural history of the plaque responsible for the future ACS is unclear.
Hypothesis: We assessed the hypothesis that coronary plaque progression detected by serial coronary computed tomography angiography (CTA) was associated with developing ACS.
Methods: We enrolled 452 known coronary artery disease patients who underwent serial CTA (age 65±11; male 85%). Median interval between 1st and 2nd CTA was 371 days, and median follow-up period was 1485 days.
The presence of high risk plaque (HRP; positive remodeling and/or low attenuation plaque) and plaque progression (defined as the increase of stenosis severity) were evaluated on CTA. ACS was defined as fatal myocardial infarction (MI), non-fatal MI, and unstable angina pectoris.
Results: ACS occurred in 17 (3.8%) patients. HRP was detected in 69 (15.3%) patients on 1st CTA. At 1st CTA, HRP (hazard ratio [HR]: 8.0; 95% confidence interval [CI]: 3.0 to 23.6; p≤0.0001) and previous MI (HR: 5.1; 95% CI: 1.4 to 32.6; p=0.011) were the independent predictors of ACS. Of 445 event-free patients at 2nd CTA, ACS occurred in 10 (2.2%) patients after 2nd CTA. Plaque progression was observed in 64 (14.4%) patients. Plaque progression (HR: 44.4; 95% CI: 5.9 to 933.8; p≤0.0001) and previous MI (HR: 7.8; 95% CI: 1.2 to 160.0; p=0.026) were the independent predictors of ACS after serial CTA. On Kaplan-Meier analysis, patients with HRP and plaque progression had higher incidence of ACS (p≤0.0001) (Figure).
Conclusions: In conclusion, plaque progression detected by serial CTA was an independent predictor of ACS as well as HRP. Serial CTA has the potential of contribution to risk stratification and secondary prevention of coronary artery disease.
- © 2013 by American Heart Association, Inc.