Abstract 16889: Coronary Computed Tomography Angiography for Long Term Prediction of Acute Coronary Syndrome
Introduction: We previously reported that coronary computed tomography angiography (CTA) had a potential to predict acute coronary syndrome (ACS) with plaque characteristics of high risk plaque (HRP; positive remodeling and/or low attenuation) with mean follow-up of 2 years.
Hypothesis: We assessed the hypothesis that the CTA would have the limitation for a long term prediction of ACS.
Methods: We enrolled 4366 patients (age 65±12years, male 68%) undergoing CTA from March 2003 to May 2012 and followed up >12 months (follow-up: mean 1144 days, maximum 3712 days) after exclusion of 434 coronary bypass graft patients.
An adverse cardiac event was defined as cardiac death and non-fatal ACS. On CTA, the presence of HRP were evaluated.
Results: Event occurred in 154 (3.5%) patients; 30 cardiac death and 124 non-fatal ACS (75 at de novo lesions, 20 at restenotic lesions, 29 at unknown culprit lesions). HRP was detected in 323 (7.4%) patients.
Of 75 patients with ACS at de novo lesions, ACS occurred in 37/323 (11.5%) HRP(+) patients and 38/4043 (0.9%) HRP(-) patients. HRP (HR 6.0, 95% CI 3.7-9.8, p<0.0001) and previous myocardial infarction (HR 3.4, 95% CI 1.8-5.3, p<0.0001) were the independent predictors of developing ACS. HRP(+) patients revealed higher incidence of ACS (log rank; p<0.0001) (left figure). The sum of ACS in HRP(+) patients and HRP(-) patients were shown in the right figure.
Although the incidence rate of ACS in HRP(-) patients were relatively low, ACS occurred in HRP(-) patients gradually, and the sum of ACS of HRP(-) patients was similar to HRP(+) patients in 6 years.
Conclusions: In conclusion, HRP on CTA was the predictor of developing ACS in 10-year follow-up. On the other hand, CTA had the limitation for long term prediction of ACS since the sum of ACS patients of HRP(-) patients was similar to HRP(+) patients in 10 years.
- © 2013 by American Heart Association, Inc.