title: Comparison of Quantity of Coronary Atherosclerotic Plaques Detected by Computed Tomography Versus Angiography.
abstract: Numerous clinical studies using coronary computed tomography angiography (CTA) and conventional invasive coronary angiography (ICA) confirmed the strong relation between atherosclerotic disease burden and risk of adverse events. Few studies have compared coronary CTA and ICA regarding semiquantitative plaque burden measurements, reproducibility, and cardiovascular risk assessment. We enrolled 71 consecutive patients (mean age 62 ± 9 years, 37% women) from the Genetic Loci and the Burden of Atherosclerotic Lesions study (NCT01738828), who underwent 256-slice multidetector row coronary CTA and ICA at a single site. On average, 42 ± 32 days passed between the 2 examinations. A total of 1,016 coronary segments were imaged by both CTA and ICA according the 18-segment Society of Cardiovascular Computed Tomography classification. We excluded 16 segments treated with coronary stents. Overall, 1,000 segments were evaluated for the presence of stenosis severity (<25%: minimal, 25% to 49%: mild, 50% to 70%: moderate, 70% to 99%: severe, 100%: occlusion). We calculated the segment involvement score (SIS) and segment stenosis score. Patients were classified into 4 groups: extensive obstructive (SIS >4 and ≥50% stenosis), extensive nonobstructive (SIS >4 and <50% stenosis), nonextensive obstructive (SIS ≤4 and ≥50% stenosis), or nonextensive nonobstructive (SIS ≤4 and <50% stenosis). CTA detected coronary artery plaques in 49%, whereas ICA showed coronary plaques in 24% of the analyzed 1,000 segments (p <0.001). CTA detected atherosclerotic plaque in 35% of coronary segments where ICA was negative, whereas ICA detected plaque only in 3% of segments where CTA was negative. CTA-based segment scores were significantly greater, SIS: 6.9 ± 3.0 versus 3.3 ± 2.0, segment stenosis score: 16.4 ± 8.8 versus 9.4 ± 6.8 (p <0.001 for both). In conclusion, coronary CTA detected approximately twice as many coronary segments with plaque compared to ICA, which resulted in 52% of the patients being assigned to a greater risk category.
authors.affiliation: MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors.forename: Márton
authors.initials: M
authors.lastname: Kolossváry
authors.affiliation: MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors.forename: Bálint
authors.initials: B
authors.lastname: Szilveszter
authors.affiliation: Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors.forename: István Ferenc
authors.initials: IF
authors.lastname: Édes
authors.affiliation: Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors.forename: Sándor
authors.initials: S
authors.lastname: Nardai
authors.affiliation: Global Genomics Group, Atlanta, Georgia; Department of Psychiatry, University of Pecs, Pecs, Hungary.
authors.forename: Viktor
authors.initials: V
authors.lastname: Voros
authors.affiliation: Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors.forename: István
authors.initials: I
authors.lastname: Hartyánszky
authors.affiliation: Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors.forename: Béla
authors.initials: B
authors.lastname: Merkely
authors.affiliation: Global Genomics Group, Atlanta, Georgia.
authors.forename: Szilard
authors.initials: S
authors.lastname: Voros
authors.affiliation: MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. Electronic address: p.maurovich.horvat@mail.harvard.edu.
authors.forename: Pál
authors.initials: P
authors.lastname: Maurovich-Horvat
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D058226:Plaque, Atherosclerotic / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors