title: Prognostic implications of non-culprit plaques in acute coronary syndrome: non-invasive assessment with coronary CT angiography.
abstract: OBJECTIVE
  Non-culprit plaques are responsible for a substantial number of future events in patients with acute coronary syndrome (ACS). In this study, we evaluated the prognostic implications of non-culprit plaques seen on coronary computed tomography angiography (CTA) in patients with ACS.
  
  
  RESULTS
  Coronary CTA was performed in 169 patients (mean 59 ± 11 years, 129 males) admitted with ACS. Data sets were assessed for the presence of obstructive non-culprit plaques (>50% luminal narrowing), segment involvement score, and quantitative measures of plaque burden, after censoring initial culprit plaques. Follow-up was performed for the occurrence of major adverse cardiovascular events (MACEs) unrelated to the initial culprit plaque; cardiac death, second ACS, or coronary revascularization after 90 days. After a median follow-up of 4.8 (IQR 2.6-6.6) years, MACE occurred in 36 (24%) patients: 6 cardiac deaths, 16 second ACS, and 14 coronary revascularizations. Dyslipidaemia (hazard ratio [HR] 3.1 [95% confidence interval 1.5-6.6]) and diabetes mellitus (HR 4.8 [2.3-10.3]) were univariable clinical predictors of MACE. Patients with remaining obstructive non-culprit plaques (HR 3.66 [1.52-8.80]) and higher plaque burden index (HR 1.22 [1.01-1.48]) had a more risk of MACE. In multivariate analysis, with diabetes, dyslipidaemia, and plaque burden index, obstructive non-culprit plaques (HR 3.76 [1.28-11.09]) remained an independent predictor of MACE.
  
  
  CONCLUSIONS
  Almost a quarter of the study population experienced a new event arising from a non-culprit plaque during a follow-up of almost 5 years. ACS patients with remaining obstructive non-culprit plaques or high plaque burden have an increased risk of future MACE.
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands a.dedic@erasmusmc.nl.
authors.forename: Admir
authors.initials: A
authors.lastname: Dedic
authors.affiliation: Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Akira
authors.initials: A
authors.lastname: Kurata
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Marisa
authors.initials: M
authors.lastname: Lubbers
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Willem Bob
authors.initials: WB
authors.lastname: Meijboom
authors.forename: Bas M
authors.initials: BM
authors.lastname: van Dalen
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: van Dalen
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Sanne
authors.initials: S
authors.lastname: Snelder
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Rebbeca
authors.initials: R
authors.lastname: Korbee
authors.affiliation: Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Adriaan
authors.initials: A
authors.lastname: Moelker
authors.affiliation: Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ouhlous
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: van Domburg
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Pim J
authors.initials: PJ
authors.lastname: de Feijter
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Koen
authors.initials: K
authors.lastname: Nieman
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality; D015415:Biomarkers / Q000032:analysis; D015897:Comorbidity; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D015415:Biomarkers; D003287:Contrast Media
keywords: Acute coronary syndrome; Coronary CT angiography; Non-culprit plaques; Plaque burden; Prognosis