title: Prognostic implications of coronary CT angiography-derived quantitative markers for the prediction of major adverse cardiac events.
abstract: OBJECTIVE
  To evaluate quantitative markers derived from coronary CT angiography (coronary CTA) for the prediction of major adverse cardiac events (MACE).
  
  
  METHODS
  Pooled data from two centers in the US and Europe were retrospectively analyzed. Forty-six patients (65.5 ± 8.1 years, 62% male) with suspected coronary artery disease (CAD) who had undergone dual-source CCTA and had experienced MACE within 12 months were included and compared to a Framingham risk score matched cohort (n = 46) without MACE. Various quantitative markers derived from coronary CTA were compared between both groups: Total plaque volume (TPV), calcified and non-calcified plaque volumes (CPV and NCPV), plaque burden (%), remodeling index, lesion length, presence of Napkin-ring sign, segment involvement score (SIS), and segment stenosis score (SSS). Discriminatory power of these markers for predicting MACE was assessed.
  
  
  RESULTS
  Patients with MACE had significantly more obstructive CAD with higher plaque burden, SSS, and SIS (all p < 0.05) compared to controls. MACE-related lesions showed higher median TPV (122.6 mm3vs. 76.3 mm3), NCPV (67.3 mm3vs. 56.1 mm3), plaque burden (66.3% vs. 44.9%), greater lesion length (23.1 mm vs. 19.2 mm), and higher prevalence of Napkin-ring sign (63% vs. 32%) (all p < 0.05). On multivariable analysis, odds ratios (OR) for MACE on a per-patient level were 1.07 for plaque burden (p = 0.0002) and 1.13 for SSS (p = 0.049). On a per-lesion basis OR for lesion length was 1.05 (p = 0.042), 1.03 for plaque burden (p = 0.018), 1.28 for remodeling index (p = 0.026), and 1.68 for the Napkin-ring sign (p = 0.031). At receiver operating characteristics analysis a combination of markers (Framingham risk score + Napkin-ring sign + lesion length + remodeling index) showed the highest predictive value for MACE (AUC 0.92, p = 0.013).
  
  
  CONCLUSIONS
  Coronary CTA-derived markers portend predictive value for MACE on a per-patient (plaque burden and SSS) and per-lesion level (lesion length, plaque burden, remodeling index, and Napkin-ring sign). A combination of markers added to the Framingham risk score has the highest predictive power.
authors: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.
authors: Christian
authors: C
authors: Tesche
authors: Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
authors: Fabian
authors: F
authors: Plank
authors: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
authors: Carlo N
authors: CN
authors: De Cecco
authors: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
authors: Taylor M
authors: TM
authors: Duguay
authors: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
authors: Moritz H
authors: MH
authors: Albrecht
authors: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
authors: Akos
authors: A
authors: Varga-Szemes
authors: Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
authors: Richard R
authors: RR
authors: Bayer
authors: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology, People's Liberation Army General Hospital, Beijing, China.
authors: Junjie
authors: J
authors: Yang
authors: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
authors: Isaac L
authors: IL
authors: Jacks
authors: Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Germany.
authors: Bettina M
authors: BM
authors: Gramer
authors: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.
authors: Ullrich
authors: U
authors: Ebersberger
authors: Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.
authors: Ellen
authors: E
authors: Hoffmann
authors: Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors: Salvatore A
authors: SA
authors: Chiaramida
authors: Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
authors: Gudrun
authors: G
authors: Feuchtner
authors: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: schoepf@musc.edu.
authors: U Joseph
authors: UJ
authors: Schoepf
mesh_terms: D000368:Aged; D019540:Area Under Curve; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013022:South Carolina; D013997:Time Factors; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy
keywords: Coronary artery disease; Coronary computed tomography angiography; Plaque characterization; Prognosis