title: Noncalcified atherosclerotic lesions with vulnerable characteristics detected by coronary CT angiography and future coronary events.
abstract: BACKGROUND
  The ability of coronary CT angiography (CTA) findings such as plaque characteristics to predict future coronary events remains controversial.
  
  
  OBJECTIVE
  We investigated whether noncalcified atherosclerotic lesions (NCALs) detected by coronary CTA were predictive of future coronary events.
  
  
  METHODS
  A total of 511 patients who underwent coronary CTA were followed for cardiovascular events over a period of 3.3 ± 1.2 years. The primary end point was defined as hard events, including cardiac death, nonfatal myocardial infarction, or unstable angina that required urgent hospitalization. Early elective coronary revascularizations (n = 58) were excluded. The relationship between features of NCALs and outcomes is described.
  
  
  RESULTS
  A total of 15 hard events (2 cardiac deaths, 7 myocardial infarctions, 6 cases of unstable angina that required urgent hospitalization) were documented in the remaining 453 patients with modest risks during a follow-up period of 3.3 ± 1.2 years. For these hard events, a univariate Cox proportional hazard model showed that the hazard ratio for the presence of >50% stenosis was 7.27 (95% CI, 2.62-21.7; P = .0002). Although the presence of NCAL by itself was not statistically significant, NCALs with low attenuation and positive remodeling (low-attenuation plaque [LAP] and positive remodeling [PR]; plaque CT number ≤ 34 HU and remodeling index ≥ 1.20) showed an adjusted hazard ratio of 11.2 (95% CI, 3.71-36.7; P < .0001). With C-statistics analysis, when both LAP and PR and >50% stenosis were added, the C-statistic was significantly improved compared with the basal model adjusted for age, sex, and log2 (Agatston score +1) (0.900 vs 0.704; P = .0018).
  
  
  CONCLUSIONS
  Identification of NCALs with LAP and PR characteristics by coronary CTA provides additional prognostic information to coronary stenosis for the prediction of future coronary events.
authors.affiliation: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8551, Japan. hideyayama@hiroshima-u.ac.jp
authors.forename: Hideya
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kitagawa
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ohashi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Utsunomiya
authors.forename: Eiji
authors.initials: E
authors.lastname: Kunita
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Oka
authors.forename: Yoji
authors.initials: Y
authors.lastname: Urabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tsushima
authors.forename: Kazuo
authors.initials: K
authors.lastname: Awai
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kihara
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011857:Radiographic Image Interpretation, Computer-Assisted; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Coronary CT angiography; Low-attenuation plaque; Noncalcified atherosclerotic lesion; Positive remodeling; Prognosis