Author + information
- Received November 21, 2018
- Revision received June 10, 2019
- Accepted June 17, 2019
- Published online August 14, 2019.
- Daniele Andreini, MD, PhDa,b,∗∗ (, )
- Marco Magnoni, MDc,∗,
- Edoardo Conte, MDa,
- Serge Masson, PhDd,
- Saima Mushtaq, MDa,
- Sergio Berti, MDe,
- Mauro Canestrari, MDf,
- Giancarlo Casolo, MDg,
- Domenico Gabrielli, MDh,
- Roberto Latini, MDd,
- Paolo Marraccini, MDi,
- Tiziano Moccetti, MDj,
- Maria Grazia Modena, MDk,
- Gianluca Pontone, MD, PhDa,
- Marco Gorini, MSl,
- Aldo P. Maggioni, MDl,
- Attilio Maseri, MDc,
- on behalf of the CAPIRE Investigators
- aCentro Cardiologico Monzino, Institute for Research, Hospitalization and Health Care, Milan, Italy
- bDepartment of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
- cHeart Care Foundation Onlus, Florence, Italy
- dDepartment of Cardiovascular Research, Istituto di Ricerche Farmacologiche “Mario Negri,” Institute for Research, Hospitalization and Health Care, Milan, Italy
- eUO Adult Cardiology, Stabilimento di Massa, Fondazione Toscana G. Monasterio per la Ricerca Medica e di Sanità, Massa, Italy
- fDepartment of Cardiology, Santa Croce Hospital, Fano, Italy
- gDepartment of Cardiology, Nuovo Ospedale Versilia, Lido di Camaiore, Italy
- hDepartment of Cardiology, Ospedale Civile A. Murri, Fermo, Italy
- iClinical Psychology Institute, Consiglio Nazionale delle Richerche, Fondazione Toscana G. Monasterio, S.A. Emodinamica, Pisa, Italy
- jCardiovasclar Research Service, Cardiocentro Ticino, Lugano, Switzerland
- kDepartment of Cardiology, Ospedale Policlinico, Modena, Italy
- lANMCO Research Center, Heart Care Foundation Onlus, Florence, Italy
- ↵∗Address for correspondence:
Dr. Daniele Andreini, Centro Cardiologico Monzino, IRCCS, University of Milan, Department of Clinical Sciences and Community Health, Cardiovascular Section, Via Carlo Parea 4, 20138 Milan, Italy.
Objectives This study sought to assess whether coronary atherosclerosis analysis by coronary computed tomography angiography (CTA) may improve prognostic stratification among patients with diffuse coronary artery disease (CAD)
Background Coronary CTA has recently emerged as a promising noninvasive tool for advanced analysis of coronary atherosclerosis.
Methods The multicenter CAPIRE (Coronary Atherosclerosis in outlier subjects: Protective and novel Individual Risk factors Evaluation) study is part of the GISSI Outlier Project. A prospective cohort of subjects who underwent coronary CTA for suspected CAD was enrolled. Based on risk factor (RF) burden, patients were defined as having a low clinical risk (0 to 1 RF with the exclusion of patients with diabetes mellitus as single RF) or at high clinical risk (3 or more RFs). Patients with 2 RFs were not enrolled in the study. Coronary CTA advanced plaque assessment was performed. Outcome measures were 3 combined endpoints: acute coronary syndrome (ACS), cardiac death + ACS, and cardiac death + ACS + late revascularization.
Results Among the 544 patients enrolled in the CAPIRE study, in 522 patients, a mean follow-up of 37 ± 10 months was obtained (16 patients were excluded due to 1 < segment involvement score <5 at core lab coronary CTA analysis and 6 patients were lost at follow-up). Higher atherosclerotic burden was found in patients with higher clinical risk, but prevalence of elevated noncalcified plaque volume did not significantly differ between low- versus high-risk patients. Quantitative plaque parameters by coronary CTA were associated with composite endpoints at multivariable analysis when corrected for univariate predictors. Elevated noncalcified plaque volume, expressed as dichotomic variable, was associated with all combined endpoints. Even if the low absolute number of events represents a limitation to the present study, patients with low noncalcified plaque volume had similar risk of cardiac events independently from the presence of multivessel disease, while patients with high noncalcified plaque volume had higher rates of cardiac events.
Conclusions The CAPIRE study confirmed the prognostic value of atherosclerosis assessment by coronary CTA, demonstrating high noncalcified plaque volume as the most ACS-predictive parameter in patients with extensive CAD. (GISSE Outliers CAPIRE [CAPIRE]; NCT02157662)
↵∗ Drs. Andreini and Magnoni contributed equally to this work.
The study is promoted by GISSI Group (Italian Association of Hospital Cardiologists, Mario Negri Institute, and Heart Care Foundation Onlus). The sponsor of the study is the Heart Care Foundation Onlus, an independent nonprofit institution. The study is partially supported by an unrestricted grant by Ferrero Spa and from the contributions collected by the Heart Care Foundation Onlus, in the years 2009 and 2010, from the fundraising campaigns “Accendi il tuo cuore.” Dr. Andreini has served on the Speakers Bureau for GE Healthcare; has received institutional research grant support from GE Healthcare, Bracco, and HeartFlow; and has received speaker fees from GE Healthcare, Bracco, Bayer, and Medtronic. Dr. Pontone has received an institutional fee as speaker and/or research grant from GE Healthcare, Bracco, Bayer, Medtronic, and HeartFlow. Dr. Maggioni has received consulting honoraria from Novartis, Bayer, and Fresenius. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 21, 2018.
- Revision received June 10, 2019.
- Accepted June 17, 2019.
- 2019 American College of Cardiology Foundation
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