title: The presence of remodeled and mixed atherosclerotic plaques at coronary ct angiography predicts major cardiac adverse events - The CAFÉ-PIE Study.
abstract: BACKGROUND
  It is still unclear how to exploit information made available by coronary computed tomography angiography (CCTA) on coronary artery disease (CAD) features in order to better predicting major adverse cardiac events (MACEs). Aim of this study was to validate the prognostic role of a comprehensive and simplified CT-derived score in patients evaluated for suspected CAD.
  
  
  METHODS
  A prospective registry included 477 consecutive symptomatic patients without known CAD who underwent clinically-indicated CCTA. All patients were followed-up for MACE occurrence for a period of 49±15-month.
  
  
  RESULTS
  The mean CT Score was 10.5±10.8, with a MACE rate of 11.3%. There was a stepwise relationship between MACE rate during follow-up and CT Score values. MACEs were 1.9% in patients with CT Score<10 (reference group), 16.6% in those with CT Score 10-20 (OR 9.9, 95% C.I. 3.5-27.8 vs. reference group, p<0.001), 24.5% in those with CT Score 21-30 (OR 16.6, 95% C.I. 6.1-45.0 vs. reference group, p<0.001), and 47.4% in those with CT Score>30 (OR 46.1, 95% C.I. 13.0-162.9 vs. reference group, p<0.001) (p for trend <0.001). At ROC curve analysis, CT Score was the best predictor of MACE (AUC: 0.81, CI 95%: 0.78-0.84) as compared to Diamond and Forrester score (p<0.001), segment stenosis score (p<0.05) and segment involved score (p<.0.01).
  
  
  CONCLUSIONS
  The use of an integrated score obtained with CCTA and based on the presence of remodeled and mixed atherosclerotic coronary plaques may improve MACE prediction in symptomatic patients at intermediate risk outweighing that provided by standard clinical and CCTA scores.
authors.affiliation: Cardiology Unit, Department of Emergency and Organ Transplantation, University Hospital "Policlinico Consorziale" of Bari, Bari, Italy; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. Electronic address: andrea.guaricci@gmail.com.
authors.forename: Andrea Igoren
authors.initials: AI
authors.lastname: Guaricci
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Fiorella
authors.initials: F
authors.lastname: De Rosa
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Deodata
authors.initials: D
authors.lastname: Montrone
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Guglielmo
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Saima
authors.initials: S
authors.lastname: Mushtaq
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Fusini
authors.affiliation: Centre de Recherche, Department of Radiology, Montreal Heart Institute, Universitè de Montreal, QC, Canada.
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.affiliation: Centre de Recherche, Department of Radiology, Montreal Heart Institute, Universitè de Montreal, QC, Canada; Department of Radiology, Erasmus Medical Center University, Rotterdam, The Netherlands.
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.affiliation: Department of Radiology, University of Foggia, Foggia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Macarini
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Biase
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000368:Aged; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors
keywords: Computed tomography; Coronary artery disease; Outcome; Prognosis