Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes With CCTA
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Author + information
- Sang-Eun Lee, MD, PhDa,b,c,
- Ji Min Sung, PhDa,b,
- Daniele Andreini, MD, PhDd,
- Mouaz H. Al-Mallah, MDe,
- Matthew J. Budoff, MDf,
- Filippo Cademartiri, MD, PhDg,
- Kavitha Chinnaiyan, MDh,
- Jung Hyun Choi, MD, PhDi,
- Eun Ju Chun, MD, PhDj,
- Edoardo Conte, MDd,
- Ilan Gottlieb, MD, PhDk,
- Martin Hadamitzky, MDl,
- Yong Jin Kim, MD, PhDm,
- Byoung Kwon Lee, MD, PhDn,
- Jonathon A. Leipsic, MDo,
- Erica Maffei, MDp,
- Hugo Marques, MD, PhDq,
- Pedro de Araújo Gonçalves, MD, PhDq,
- Gianluca Pontone, MD, PhDd,
- Gilbert L. Raff, MDh,
- Sanghoon Shin, MDc,
- Peter H. Stone, MDr,
- Habib Samady, MDs,
- Renu Virmani, MDt,
- Jagat Narula, MD, PhDu,
- Daniel S. Berman, MDv,
- Leslee J. Shaw, PhDw,
- Jeroen J. Bax, MD, PhDx,
- Fay Y. Lin, MDw,
- James K. Min, MDw and
- Hyuk-Jae Chang, MD, PhDa,b,∗ (hjchang{at}yuhs.ac)
- aDivision of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- bYonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
- cDivision of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
- dCentro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- eHouston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
- fDepartment of Medicine, Los Angeles Biomedical Research Institute, Torrance, California
- gCardiovascular Imaging Unit, SDN IRCCS, Naples, Italy
- hDepartment of Cardiology, William Beaumont Hospital, Royal Oak, Minnesota
- iPusan University Hospital, Busan, South Korea
- jSeoul National University Bundang Hospital, Seongnam, South Korea
- kDepartment of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
- lDepartment of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
- mDepartment of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
- nGangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- oDepartment of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- pDepartment of Radiology, Area Vasta 1/ Azienda Sanitaria Unica Regionale (ASUR) Marche, Urbino, Italy
- qUNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
- rDivision of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- sDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- tDepartment of Pathology, CVPath Institute, Gaithersburg, Maryland
- uIcahn School of Medicine at Mount Sinai, New York, New York
- vDepartment of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- wDepartment of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
- xDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- ↵∗Address for correspondence:
Dr. Hyuk-Jae Chang, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
Central Illustration
Abstract
Objectives This study explored whether the pattern of nonobstructive lesion progression into obstructive lesions would differ according to the presence of high-risk plaque (HRP).
Background It is still debatable whether HRP simply represents a certain phase during the natural history of coronary atherosclerotic plaques or if disease progression would differ according to the presence of HRP.
Methods Patients with nonobstructive coronary artery disease, defined as percent diameter stenosis (%DS) <50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. HRP was defined as lesions with ≥2 features of positive remodeling, spotty calcification, or low-attenuation plaque. Quantitative total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions.
Results A total of 3,049 nonobstructive lesions were identified from 1,297 patients (mean age 60.3 ± 9.3 years; 56.8% men). There were 2,624 non-HRP and 425 HRP lesions. HRP lesions had a greater total PAV and all noncalcified components of PAV and %DS at baseline compared with non-HRP lesions. However, the annualized total PAV changes were greater in non-HRP lesions than in HRP lesions. On multivariate analysis adjusted for clinical risk factors, drug use, change in lipid level, total PAV, %DS, and HRP, only the baseline total PAV and %DS independently predicted the development of obstructive lesions (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02 to 1.07, and HR: 1.07; 95% CI: 1.04 to 1.10, respectively, all p < 0.05), whereas the presence of HRP did not (p > 0.05).
Conclusions The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV, not the presence of HRP features, was the most important predictor of lesions developing into obstructive lesions. (Progression of Atherosclerotic Plaque Determined By Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411)
- coronary artery atherosclerosis
- coronary artery disease
- coronary computed tomography angiography
- high-risk plaque
Footnotes
This work was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science and ICT (MSIT) (Grant No. 2012027176). The study was also funded in part by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Budoff has received a grant from General Electric. Dr. Chinnaiyan is a member of the Medical Advisory Board for HeartFlow. Dr. Leipsic has been a consultant for and holds stock in Circle CVI and HeartFlow; and has been a member of the Speakers Bureau and has received research support from GE Healthcare. Dr. Habib Samady has served on the Scientific Advisory Board of Philips; is the co-founder and holds equity interest in Covanos Inc.; and has received a research grant from Medtronic. Dr. Berman has received software royalties from Cedars-Sinai Medical. Dr. Bax has received speaker fees from Abbott. Dr. Min has received funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare; has served on the Scientific Advisory Board of Arineta and GE Healthcare; and has an equity interest in Cleerly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Harvey Hecht, MD, served as Guest Editor for this paper.
- Received July 1, 2019.
- Revision received August 21, 2019.
- Accepted September 13, 2019.
- 2019 American College of Cardiology Foundation
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