Author + information
- Received February 14, 2020
- Revision received March 24, 2020
- Accepted March 31, 2020
- Published online October 5, 2020.
- Subhi J. Al’Aref, MDa,∗ (, )
- Gurpreet Singh, PhDb,
- Jeong W. Choi, MDc,
- Zhuoran Xu, MDc,
- Gabriel Maliakal, MScd,
- Alexander R. van Rosendael, MDc,
- Benjamin C. Lee, PhDc,
- Zahra Fatima, BSc,
- Daniele Andreini, MD, PhDe,
- Jeroen J. Bax, MD, PhDf,
- Filippo Cademartiri, MD, PhDg,
- Kavitha Chinnaiyan, MDh,
- Benjamin J.W. Chow, MDi,
- Edoardo Conte, MDe,
- Ricardo C. Cury, MDj,
- Gudruf Feuchtner, MDk,
- Martin Hadamitzky, MDl,
- Yong-Jin Kim, MDm,
- Sang-Eun Lee, MDn,o,
- Jonathon A. Leipsic, MDp,
- Erica Maffei, MDq,
- Hugo Marques, MDr,
- Fabian Plank, MDs,
- Gianluca Pontone, MD, PhDe,
- Gilbert L. Raff, MDh,
- Todd C. Villines, MDt,
- Harald G. Weirich, MDs,
- Iksung Cho, MDn,u,
- Ibrahim Danad, MDv,
- Donghee Han, MDw,
- Ran Heo, MDx,
- Ji Hyun Lee, MDw,y,
- Asim Rizvi, MDz,
- Wijnand J. Stuijfzand, MDc,
- Heidi Gransar, MScaa,
- Yao Lu, MScc,
- Ji Min Sung, PhDw,
- Hyung-Bok Park, MDw,
- Daniel S. Berman, MDbb,
- Matthew J. Budoff, MDcc,
- Habib Samady, MDdd,
- Peter H. Stone, MDee,
- Renu Virmani, MDff,
- Jagat Narula, MD, PhDgg,
- Hyuk-Jae Chang, MD, PhDn,
- Fay Y. Lin, MDc,
- Lohendran Baskaran, MDc,hh,
- Leslee J. Shaw, PhDc and
- James K. Min, MDd
- aDivision of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- bGlaxoSmithKline, Brentford, United Kingdom
- cDepartment of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York
- dCleerly Health, New York, New York
- eCentro Cardiologico Monzino, Institute for Research Hospitalization, and Health Care, Milan, Italy
- fDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- gCardiovascular Imaging Center, Institute of Diagnostic and Nuclear Development, Institute for Research Hospitalization, and Health Care, Naples, Italy
- hDepartment of Cardiology, William Beaumont Hospital, Royal Oak, Michigan
- iDepartment of Medicine and Radiology, University of Ottawa, Ottawa, Canada
- jDepartment of Radiology, Miami Cardiac and Vascular Institute, Miami, Florida
- kDepartment of Radiology, Medical University of Innsbruck, Innsbruck, Austria
- lDepartment of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
- mDepartment of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- nDivision of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University Health System, Yonsei University College of Medicine, Seoul, South Korea
- oYonsei–Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Yonsei University College of Medicine, South Korea
- pDepartment of Medicine and Radiology, University of British Columbia, Vancouver, Canada
- qDepartment of Radiology, ASUR Marche Area Vasta 1, Urbino, Italy
- rCardiovascular Imaging Unit, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal
- sDepartment of Radiology, Innsbruck Medical University, Innsbruck, Austria
- tDivision of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
- uDepartment of Cardiology, Chung-Ang University Hospital, Seoul, South Korea
- vDepartment of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
- wIntegrative Cardiovascular Imaging Research Center, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
- xDivision of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Korea
- yDepartment of Cardiology, Myongji Hospital, Goyang, South Korea
- zDepartment of Radiology, Mayo Clinic, Rochester, Minnesota
- aaDepartment of Imaging, Cedars Sinai Medical Center, Los Angeles, California
- bbDepartment of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, California
- ccDepartment of Medicine, Los Angeles Biomedical Research Institute, Torrance, California
- ddDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- eeDivision of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- ffCVPath Institute, Gaithersburg, Maryland
- ggMarie-Josée and Henry R. Kravis Center for Cardiovascular Health, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York
- hhDepartment of Cardiovascular Medicine, National Heart Centre, Singapore
- ↵∗Address for correspondence:
Dr. Subhi J. Al’Aref, Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences. 4301 West Markham Street, Little Rock, Arkansas 72205.
Objectives This study sought to identify culprit lesion (CL) precursors among acute coronary syndrome (ACS) patients based on qualitative and quantitative computed tomography–based plaque characteristics.
Background Coronary computed tomography angiography (CTA) has been validated for patient-level prediction of ACS. However, the applicability of coronary CTA to CL assessment is not known.
Methods Utilizing the ICONIC (Incident COroNary Syndromes Identified by Computed Tomography) study, a nested case-control study of 468 patients with baseline coronary CTA, the study included ACS patients with invasive coronary angiography–adjudicated CLs that could be aligned to CL precursors on baseline coronary CTA. Separate blinded core laboratories adjudicated CLs and performed atherosclerotic plaque evaluation. Thereafter, the study used a boosted ensemble algorithm (XGBoost) to develop a predictive model of CLs. Data were randomly split into a training set (80%) and a test set (20%). The area under the receiver-operating characteristic curve of this model was compared with that of diameter stenosis (model 1), high-risk plaque features (model 2), and lesion-level features of CL precursors from the ICONIC study (model 3). Thereafter, the machine learning (ML) model was applied to 234 non-ACS patients with 864 lesions to determine model performance for CL exclusion.
Results CL precursors were identified by both coronary angiography and baseline coronary CTA in 124 of 234 (53.0%) patients, with a total of 582 lesions (containing 124 CLs) included in the analysis. The ML model demonstrated significantly higher area under the receiver-operating characteristic curve for discriminating CL precursors (0.774; 95% confidence interval [CI]: 0.758 to 0.790) compared with model 1 (0.599; 95% CI: 0.599 to 0.599; p < 0.01), model 2 (0.532; 95% CI: 0.501 to 0.563; p < 0.01), and model 3 (0.672; 95% CI: 0.662 to 0.682; p < 0.01). When applied to the non-ACS cohort, the ML model had a specificity of 89.3% for excluding CLs.
Conclusions In a high-risk cohort, a boosted ensemble algorithm can be used to predict CL from non-CL precursors on coronary CTA.
This trial was supported by National Institutes of Health Grant No. HL115150 (to Dr. Min) and the Leading Foreign Research Institute Recruitment Program of the National Research Foundation of Korea, Ministry of Science, ICT and Future Planning (Seoul, Korea). The research reported in this manuscript was also supported, in part by, the Dalio Institute of Cardiovascular Imaging (New York, New York). Dr. Signh is an employee of GlaxoSmithKline. Dr. Bax has received speaker fees from Abbott Vascular; and received institutional research grant support from Abbott Vascular, Edwards Lifesciences, Biotronik, Bioventrix, Boston Scientific, Medtronic, and GE Healthcare. Dr. Chinnaiyan has received institutional research grant support and served as a consultant for HeartFlow. Dr. Chow is the Saul and Edna Goldfarb Chair in Cardiac Imaging Research; and has received research grant support from TD Bank, CV Diagnostics and AusculSciences, Siemens Healthineers, and TeraRecon; and owns equity in GE Healthcare. Dr. Cury has served as a consultant for GE Healthcare, Cleerly Health, and Spreemo Health. Dr. Leipsic has served as a consultant for and owns stock options in HeartFlow and Circle CVI; and received research grant support from and served on the Speakers Bureau for GE Healthcare. Dr. Pontone has a research grant and/or honorarium as a speaker from GE Healthcare, Bracco, Bayer, Medtronic, and HeartFlow. Dr. Berman has received research grant support from HeartFlow and software royalties from Cedars-Sinai Medical Center. Dr. Budoff received research grant support from the National Institutes of Health and GE Healthcare. Dr. Samady has served as a consultant and received research grant support from Philips; has received institutional research grant support from Abbott Vascular, Medtronic, and Philips; is co-founder of Covanos; and owns equity in Covanos and SIG. Dr. Shaw owns equity in Cleerly Health. Dr. Min has received funding from the Dalio Foundation, the National Institutes of Health, and GE Healthcare; has served on the scientific advisory board of Arineta and GE Healthcare; and previously worked at Weill Cornell Medicine but is now an employee of and owns equity in Cleerly Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Harvey Hecht, MD, was Guest Editor on this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received February 14, 2020.
- Revision received March 24, 2020.
- Accepted March 31, 2020.
- 2020 American College of Cardiology Foundation
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