Abstract 18716: Quantifying Total Atherosclerotic Burden Non-Invasively Through Coronary Computed Tomography Angiography: A Comparison With Multivessel Intravascular Ultrasound Data
Introduction: The extension of atherosclerotic disease is one the most powerful predictors of cardiovascular outcomes. Accurate methods that quantify coronary disease extension may be useful in assessing prognosis, guiding treatment and evaluating disease progression. While intravascular ultrasound (IVUS) is the gold-standard method to quantify atherosclerosis, coronary computed tomography angiography (CCTA) is a promising non-invasive alternative.
Hypothesis: We compared previously proposed and novel CCTA scores to multivessel IVUS parameters in order to explore the best way to non-invasively assess the global extent of coronary atherosclerotic disease.
Methods: Patients with high risk coronary disease referred for percutaneous coronary intervention were prospectively enrolled. For all cases, CCTA and multivessel IVUS imaging were obtained. Calcium score and 4 previously reported CCTA scores were calculated and compared to average IVUS derived percent atheroma volume (PAV). A novel score was created through comparison with IVUS. Spearman’s correlation coefficients were used to correlate score data with IVUS PAV. Receiver-operating characteristics (ROC) curves were created to establish the ability of each score to predict a PAV above the median.
Results: 62 patients with a mean age of 59.7 ± 9.2 years were enrolled. 67.7% were males, 41.9% diabetics and 75.8% had multivessel coronary disease. In average, 3.8 ± 0.7 vessels, comprising 123.8 ± 31.3 mm in length, were imaged with IVUS per patient. All evaluated scoring systems, with the exception of the CONFIRM score, correlated significantly with IVUS derived percent atheroma volume. A novel “soft plaque” CCTA score, that excludes segments with purely calcified plaques, showed the strongest correlation with IVUS PAV (ρ=0.73, p<0.001). It also showed the greatest area under the ROC curve (C-index 0.90) to predict PAV above the median.
Conclusion: A soft plaque score that takes into account the number of segments with significant non-calcified or mixed plaques correlates strongly - and better than previously described scores - with multivessel IVUS percent atheroma volume. This is possibly the most sensible way to quantify total coronary atherosclerotic burden non-invasively through CCTA.
Author Disclosures: R.C. Silva: None. T.P. Lima: None. B.A. Falcao: None. G.R. Morais: None. A.G. Spadaro: None. J. Mariani: None. E.E. Ribeiro: None. R. Kalil: None. C.E. Rochitte: None. P.A. Lemos: None.
- © 2014 by American Heart Association, Inc.