title: Characteristics of high-risk coronary plaques identified by computed tomographic angiography and associated prognosis: a systematic review and meta-analysis.
abstract: To clarify the potential role of coronary computed tomographic angiography (CCTA) in characterizing and prognosticating high-risk coronary plaques. A systematic review and meta-analysis were conducted to compare high-risk vs. low-risk plaques and culprit vs. non-culprit lesions in patients with acute coronary syndrome (ACS) vs. stable angina (SA). High-risk plaques were defined by at least one of the following features: non-calcified plaque (NCP), the presence of spotty calcified plaque (SCP), or increased remodelling index (RI). Results of included studies were pooled as odds ratios (OR) or weighted mean differences (WMD) with 95% confidence interval (CI). Eighteen eligible studies provided data to compare plaque types, plaque volume, and RI. Six studies provided data on ACS events in vulnerable high-risk vs. low-risk calcified plaques after 35 ± 2 months of follow-up. ACS patients had significantly higher number of NCP and SCP compared with SA patients with OR = 1.96 (1.47-2.60; 95% CI) P = 0.0001 and OR = 4.5 (2.98-6.83; 95% CI) P = 0.0001, respectively. Total plaque volume in ACS was not larger than SA: WMD = 22.9 (-22.1 to 67; 95% CI) mm(3), P = 0.32, but NCP volume was significantly larger: WMD = 28.8 (10.9-46.7; 95% CI) mm(3), P = 0.002. RI was higher in culprit lesions in ACS compared with SA and compared with non-culprit lesions in ACS patients: WMD = 0.48 (0.25-0.70; 95% CI) P = 0.0001 and 0.19 (0.07-0.30) P = 0.0001, respectively. The associated risk of future ACS was significantly higher in high-risk than in low-risk plaques: OR = 12.1 (5.24-28.1; 95% CI) P = 0.0001. CCTA can non-invasively characterize high-risk vulnerable coronary plaques and can predict future ACS events in patients with high-risk plaques.
authors.affiliation: Division of Cardiology, Department of Medicine, Glostrup University Hospital, Nordre Ringvej 57, 2600 Glostrup, Copenhagen, Denmark allimac_fjord@hotmail.com.
authors.forename: Camilla
authors.initials: C
authors.lastname: Thomsen
authors.affiliation: Division of Cardiology, Department of Medicine, Glostrup University Hospital, Nordre Ringvej 57, 2600 Glostrup, Copenhagen, Denmark.
authors.forename: Jawdat
authors.initials: J
authors.lastname: Abdulla
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D006801:Humans; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: angiography; computed tomography; coronary artery; myocardial infarction; plaque