Evaluation of coronary plaque characteristics with coronary computed tomography angiography in patients with non-obstructive coronary artery disease: a long-term follow-up study.
OBJECTIVE
Recent studies suggested that even non-obstructive coronary artery disease (CAD) increases major cardiovascular adverse events (MACE) rate. Aim of this study was to evaluate whether coronary computed tomography angiography (CCTA) may detect specific plaque characteristics that may affect prognosis in patients with non-obstructive CAD.


METHODS
We enrolled 245 patients who underwent CCTA between April 2004 and April 2007 for suspected CAD and were found to have non-obstructive CAD. Positive remodelling index (PRI), low-attenuation plaque (LAP), plaque burden (PB), spotty calcification (SC), and napkin-ring sign (NRS) have been evaluated for each coronary plaque detected. Acute coronary syndrome, all-cause/cardiac death, and very late elective revascularization (vl-ER) were the endpoints of the study.


RESULTS
A total of 28 events were recorded (2 STEMI, 4 NSTEMI, 6 UA, 2 cardiac deaths, 4 non-cardiac death, and 10 vl-ERs) at long-term follow-up (98 ± 20 months). When adjusted for significant clinical variables PRI > 1.4 (HR 3.31 CI 95% 1.11-9.91, P = 0.0392), LAP (HR 8.45 CI 95% 2.22-32.21, P = 0.0019), PB > 0.7 (HR 5.25 CI 95% 1.45-19.03, P = 0.0120), and NRS (HR 12.52 CI 95% 1.51-103.90, P = 0.0198) were still significantly associated with higher rate of hard cardiac events at follow-up. The Kaplan-Meyer curves confirmed lower cumulative hard cardiac events-free survival in patients presenting at least one coronary plaque with two or more high-risk characteristics when compared with patients with no lesion with more than one high-risk plaque characteristics (log-rank P < 0.0001).


CONCLUSIONS
High-risk plaque characteristics at CCTA (PRI > 1.4, PB > 0.7, LAP, and NRS) seem to be promising for risk stratification of patients with non-obstructive CAD.
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.
Edoardo
E
Conte
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.
Andrea
A
Annoni
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.
Gianluca
G
Pontone
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.
Saima
S
Mushtaq
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.
Marco
M
Guglielmo
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.
Andrea
A
Baggiano
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.
Valentina
V
Volpato
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.
Cecilia
C
Agalbato
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.
Alice
A
Bonomi
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.
Fabrizio
F
Veglia
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.
Alberto
A
Formenti
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.|Department of Clinical Sciences and Community Health, Cardiovascular Section,University of Milan, Milan, Italy.
Cesare
C
Fiorentini
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.|Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy.
Antonio L
AL
Bartorelli
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.
Mauro
M
Pepi
Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.|Department of Clinical Sciences and Community Health, Cardiovascular Section,University of Milan, Milan, Italy.
Daniele
D
Andreini
D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D023921:Coronary Stenosis; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate
atherosclerosis; coronary computed tomography angiography; non-obstructive coronary artery disease; prevention; vulnerable plaque