title: Computed tomography-based high-risk coronary plaque score to predict acute coronary syndrome among patients with acute chest pain--Results from the ROMICAT II trial.
abstract: BACKGROUND
  Coronary computed tomography angiography (CTA) can be used to detect and quantitatively assess high-risk plaque features.
  
  
  OBJECTIVE
  To validate the ROMICAT score, which was derived using semi-automated quantitative measurements of high-risk plaque features, for the prediction of ACS.
  
  
  METHODS
  We performed quantitative plaque analysis in 260 patients who presented to the emergency department with suspected ACS in the ROMICAT II trial. The readers used a semi-automated software (QAngio, Medis medical imaging systems BV) to measure high-risk plaque features (volume of <60HU plaque, remodeling index, spotty calcium, plaque length) and diameter stenosis in all plaques. We calculated a ROMICAT score, which was derived from the ROMICAT I study and applied to the ROMICAT II trial. The primary outcome of the study was diagnosis of an ACS during the index hospitalization.
  
  
  RESULTS
  Patient characteristics (age 57 ± 8 vs. 56 ± 8 years, cardiovascular risk factors) were not different between those with and without ACS (prevalence of ACS 7.8%). There were more men in the ACS group (84% vs. 59%, p = 0.005). When applying the ROMICAT score derived from the ROMICAT I trial to the patient population of the ROMICAT II trial, the ROMICAT score (OR 2.9, 95% CI 1.4-6.0, p = 0.003) was a predictor of ACS after adjusting for gender and ≥ 50% stenosis. The AUC of the model containing ROMICAT score, gender, and ≥ 50% stenosis was 0.91 (95% CI 0.86-0.96) and was better than with a model that included only gender and ≥ 50% stenosis (AUC 0.85, 95%CI 0.77-0.92; p = 0.002).
  
  
  CONCLUSIONS
  The ROMICAT score derived from semi-automated quantitative measurements of high-risk plaque features was an independent predictor of ACS during the index hospitalization and was incremental to gender and presence of ≥ 50% stenosis.
authors.affiliation: Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: ferencik@ohsu.edu.
authors.forename: Maros
authors.initials: M
authors.lastname: Ferencik
authors.affiliation: Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mayrhofer
authors.affiliation: Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria.
authors.forename: Stefan B
authors.initials: SB
authors.lastname: Puchner
authors.affiliation: Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lu
authors.affiliation: MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.
authors.forename: Pal
authors.initials: P
authors.lastname: Maurovich-Horvat
authors.affiliation: Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Liu
authors.affiliation: Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Khristine
authors.initials: K
authors.lastname: Ghemigian
authors.affiliation: Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands; Medis Medical Imaging Systems B.V, Leiden, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Kitslaar
authors.affiliation: Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Alexander
authors.initials: A
authors.lastname: Broersen
authors.affiliation: Department of Radiology, University of Tuebingen, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.affiliation: Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Schlett
authors.affiliation: Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000209:etiology; D019540:Area Under Curve; D001331:Automation; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012984:Software; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging
keywords: Acute chest pain; Acute coronary syndrome; Coronary atherosclerotic plaque; Coronary computed tomography angiography; Risk score