title: Plaque Characterization by Coronary Computed Tomography Angiography and the Likelihood of Acute Coronary Events in Mid-Term Follow-Up.
abstract: BACKGROUND
  Coronary computed tomography angiography (CTA)-verified positive remodeling and low attenuation plaques are considered morphological characteristics of high-risk plaque (HRP) and predict short-term risk of acute coronary syndrome (ACS).
  
  
  OBJECTIVE
  This study evaluated whether plaque characteristics by CTA predict mid-term likelihood of ACS.
  
  
  METHODS
  The presence of HRP and significant stenosis (SS) of ≥70% were evaluated in 3,158 patients undergoing CTA. Serial CTA was performed in 449 patients, and plaque progression (PP) was evaluated. Outcomes (fatal and nonfatal ACS) were recorded during follow-up (mean 3.9 ± 2.4 years).
  
  
  RESULTS
  ACS occurred in 88 (2.8%) patients: 48 (16.3%) of 294 HRP(+) and 40 (1.4%) of 2,864 HRP(-) patients. ACS was also significantly more frequent in SS(+) (36 of 659; 5.5%) than SS(-) patients (52 of 2,499; 2.1%). HRP(+)/SS(+) (19%) and HRP(+)/SS(-) (15%) had higher rates of ACS compared with no-plaque patients (0.6%). Although ACS incidence was relatively low in HRP(-) patients, the cumulative number of patients with ACS developing from HRP(-) lesions (n = 43) was similar to ACS patients with HRP(+) lesions (n = 45). In patients with serial CTA, PP also was an independent predictor of ACS, with HRP (27%; p < 0.0001) and without HRP (10%) compared with HRP(-)/PP(-) patients (0.3%).
  
  
  CONCLUSIONS
  CTA-verified HRP was an independent predictor of ACS. However, the cumulative number of ACS patients with HRP(-) was similar to patients with HRP(+). Additionally, plaque progression detected by serial CTA was an independent predictor of ACS.
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan; Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: sadakom@fujita-hu.ac.jp.
authors.forename: Sadako
authors.initials: S
authors.lastname: Motoyama
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Ito
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Sarai
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawai
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Yasuomi
authors.initials: Y
authors.lastname: Nagahara
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan; Department of Cardiology, Nagoya Memorial Hospital, Nagoya, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Harigaya
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan; Department of Cardiology, Nagoya Memorial Hospital, Nagoya, Japan.
authors.forename: Shino
authors.initials: S
authors.lastname: Kan
authors.affiliation: Department of Radiology, Fujita Health University, Toyoake, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Anno
authors.affiliation: Division of Medical Statistics, Fujita Health University, Toyoake, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Naruse
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Ishii
authors.affiliation: Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Harvey
authors.initials: H
authors.lastname: Hecht
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.affiliation: Department of Cardiology, Fujita Health University, Toyoake, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ozaki
authors.affiliation: Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: narula@mountsinai.org.
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D000368:Aged; D017023:Coronary Angiography; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: acute coronary syndrome; atherosclerosis; coronary artery disease