Author + information
- David A. Halon, MB ChBa,∗ (, )
- Idit Lavi, MPHb,
- Ofra Barnett-Griness, PhDb,
- Ronen Rubinshtein, MDc,
- Barak Zafrir, MDd,
- Mali Azencot, PhDa and
- Basil S. Lewis, MDa,c
- aCardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center, Haifa, Israel
- bDepartment of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
- cRuth and Bruce Rappaport School of Medicine Technion-Israel Institute of Technology, Haifa, Israel
- dPreventive Cardiology and Rehabilitation Service, Lady Davis Carmel Medical Center, Haifa, Israel
- ↵∗Address for correspondence:
Prof. David A. Halon, Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 3436212, Israel.
Objectives We used coronary computed tomography angiography (CTA) to determine plaque characteristics predicting individual late plaque events precipitating acute coronary syndromes (ACS) in a cohort of asymptomatic type 2 diabetic patients.
Background In patients with coronary artery disease, CTA plaque characteristics may predict mid-term patient events.
Methods Asymptomatic patients with diabetes 55 to 74 years of age with no history of coronary artery disease (N = 630) underwent baseline 64-slice CTA and detailed plaque level analysis. All subsequent clinical events were recorded and adjudicated. In patients who developed ACS, culprit plaque was identified at invasive angiography and its precursor located on the baseline CTA. Plaque characteristics predicting an ACS-associated culprit plaque event were analyzed by time to event accounting for inpatient clustering of plaques and competing events.
Results Among 2,242 plaques in 499 subjects, 24 ACS culprit plaques were identified in 24 subjects during median follow-up of 9.2 years (interquartile range: 8.4 to 9.8 years). Plaque volume (upper vs. lower quartile hazard ratio [HR]: 6.9; 95% confidence interval [CI]: 1.6 to 30.8; p = 0.011), percentage of low-density plaque content <50 Hounsfield units (HR: 14.2; 95% CI: 1.9 to 108; p = 0.010), and mild plaque calcification (HR vs. all other plaques 3.3 [95% CI: 1.5 to 7.3]; p = 0.004) predicted plaque events univariately and after adjustment by clinical risk score. A culprit plaque event occurred in 13 of 376 (3.5%) high-risk plaques (HRP) (plaques with ≥2 risk predictors) versus 11 of 1,866 (0.6%) in non-HRPs (p < 0.0001), at 12 of 343 (3.5%) stenotic sites (≥50%) versus 12 of 1,899 (0.6%) nonstenotic sites (p < 0.0001) and in 7 of 131 (5.3%) HRP with stenosis (p < 0.0001 vs. all others). In 130 (20.6%) subjects, no coronary plaque was present on baseline CTA.
Conclusions In asymptomatic patients with type 2 diabetes, CTA plaque volume, percent low-density plaque content, and mild calcification predicted late plaque events. The additional presence of luminal stenosis increased the probability of an acute event.
This study was supported by a research grant from the European Foundation for the Study of Diabetes. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 25, 2018.
- Accepted February 23, 2018.
- 2018 American College of Cardiology Foundation
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