Association of High-Density Calcified 1K Plaque With Risk of Acute Coronary Syndrome.
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van Rosendael Alexander R, Narula Jagat, Lin Fay Y, van den Hoogen Inge J, Gianni Umberto, Al Hussein Alawamlh Omar, Dunham Patricia C, Peña Jessica M, Lee Sang-Eun, Andreini Daniele, Cademartiri Filippo, Chinnaiyan Kavitha, Chow Benjamin J W, Conte Edoardo, Cury Ricardo C, Feuchtner Gudrun, Hadamitzky Martin, Kim Yong-Jin, Leipsic Jonathon, Maffei Erica, Marques Hugo, de Araújo Gonçalves Pedro, Plank Fabian, Pontone Gianluca, Raff Gilbert L, Villines Todd C, Weirich Harald G, Al'Aref Subhi J, Baskaran Lohendran, Cho Iksung, Danad Ibrahim, Han Donghee, Heo Ran, Lee Ji Hyun, Rivzi Asim, Stuijfzand Wijnand J, Gransar Heidi, Lu Yao, Sung Ji Min, Park Hyung-Bok, Samady Habib, Stone Peter H, Virmani Renu, Budoff Matthew J, Berman Daniel S, Chang Hyuk-Jae, Bax Jeroen J, Min James K, Shaw Leslee J
Аннотация
OBJECTIVE: To ascertain whether the increasing density in calcified coronary plaque is associated with risk for ACS.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter case-control cohort study included individuals enrolled in ICONIC (Incident Coronary Syndromes Identified by Computed Tomography), a nested case-control study of patients drawn from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry, which included 13 study sites in 8 countries. Patients who experienced core laboratory-verified ACS after baseline CCTA (n = 189) and control individuals who did not experience ACS after baseline CCTA (n = 189) were included. Patients and controls were matched 1:1 by propensity scores for age; male sex; presence of hypertension, hyperlipidemia, and diabetes; family history of premature coronary artery disease (CAD); current smoking status; and CAD severity. Data were analyzed from November 2018 to March 2019.
EXPOSURES: Whole-heart atherosclerotic plaque volume was quantitated from all coronary vessels and their branches. For patients who underwent invasive angiography at the time of ACS, culprit lesions were coregistered to baseline CCTA lesions by a blinded independent reader. Low-density plaque was defined as having less than 130 Hounsfield units (HU); calcified plaque, as having more than 350 HU and subcategorized on a voxel-level basis into 3 strata: 351 to 700 HU, 701 to 1000 HU, and more than 1000 HU (termed 1K plaque).
MAIN OUTCOMES AND MEASURES: Association between calcium density and future ACS risk.
RESULTS: A total of 189 patients and 189 matched controls (mean [SD] age of 59.9 [9.8] years; 247 [65.3%] were male) were included in the analysis and were monitored during a mean (SD) follow-up period of 3.9 (2.5) years. The overall mean (SD) calcified plaque volume (>350 HU) was similar between patients and controls (76.4 [101.6] mm3 vs 99.0 [156.1] mm3; P = .32), but patients who experienced ACS exhibited less 1K plaque (>1000 HU) compared with controls (3.9 [8.3] mm3 vs 9.4 [23.2] mm3; P = .02). Individuals within the highest quartile of 1K plaque exhibited less low-density plaque, as a percentage of total plaque, when compared with patients within the lower 3 quartiles (12.6% [10.4%] vs 24.9% [20.6%]; P < .001). For 93 culprit precursor lesions detected by CCTA, the volume of 1K plaque was lower compared with the maximally stenotic lesion in controls (2.6 [7.2] mm3 vs 7.6 [20.3] mm3; P = .01). The per-patient and per-lesion results were similar between the 2 groups when restricted to myocardial infarction cases.
CONCLUSIONS AND RELEVANCE: Results of this study suggest that, on a per-patient and per-lesion basis, 1K plaque was associated with a lower risk for future ACS and that measurement of 1K plaque may improve risk stratification beyond plaque burden.