Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 71, Issue 22, Pages 2511-2522Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2018.02.079
Keywords
acute coronary syndrome; atherosclerosis; clinical outcome; coronary artery disease; coronary computed tomography angiography
Categories
Funding
- National Institutes of Health [HL115150, R01 HL111141, R01 HL115150, R01 118019, U01 HL 105907]
- Leading Foreign Research Institute Recruitment Program of the National Research Foundation of Korea, Ministry of Science, ICT & Future Planning
- National Research Foundation of Korea - Ministry of Science and ICT [2012027176]
- Qatar National Priorities Research Program [09-370-3-089]
- GE Healthcare
- Biotronik
- Medtronic
- Boston Scientific
- Edwards Lifesciences
- CV Diagnostix
- HeartFlow
- Bracco
- Bayer
- Netherlands Heart Institute
- National Institutes of Health
- Phillips
- Volcano
- St. Jude Medical
- Abbott
- Gilead
- 480 Biomedical
- Abbott Vascular
- ART
- BioSensors International
- Celonova
- Claret Medical
- Cook Medical
- Cordis
- MicroVention
- OrbusNeich
- ReCord
- SINO Medical Technology
- Spectranetics
- Surmodics
- Terumo Corporation
- W.L. Gore
- Xeltis
- General Electric
Ask authors/readers for more resources
BACKGROUND The association of atherosclerotic features with first acute coronary syndromes (ACS) has not accounted for plaque burden. OBJECTIVES The purpose of this study was to identify atherosclerotic features associated with precursors of ACS. METHODS We performed a nested case-control study within a cohort of 25,251 patients undergoing coronary computed tomographic angiography (CTA) with follow-up over 3.4 +/- 2.1 years. Patients with ACS and nonevent patients with no prior coronary artery disease (CAD) were propensity matched 1:1 for risk factors and coronary CTA-evaluated obstructive (>= 50%) CAD. Separate core laboratories performed blinded adjudication of ACS and culprit lesions and quantification of baseline coronary CTA for percent diameter stenosis (%DS), percent cross-sectional plaque burden (PB), plaque volumes (PVs) by composition (calcified, fibrous, fibrofatty, and necrotic core), and presence of high-risk plaques (HRPs). RESULTS We identified 234 ACS and control pairs (age 62 years, 63% male). More than 65% of patients with ACS had nonobstructive CAD at baseline, and 52% had HRP. The %DS, cross-sectional PB, fibrofatty and necrotic core volume, and HRP increased the adjusted hazard ratio (HR) of ACS (1.010 per %DS, 95% confidence interval [CI]: 1.005 to 1.015; 1.008 per percent cross-sectional PB, 95% CI: 1.003 to 1.013; 1.002 per mm(3) fibrofatty plaque, 95% CI: 1.000 to 1.003; 1.593 per mm3 necrotic core, 95% CI: 1.219 to 2.082; all p < 0.05). Of the 129 culprit lesion precursors identified by coronary CTA, three-fourths exhibited <50% stenosis and 31.0% exhibited HRP. CONCLUSIONS Although ACS increases with %DS, most precursors of ACS cases and culprit lesions are nonobstructive. Plaque evaluation, including HRP, PB, and plaque composition, identifies high-risk patients above and beyond stenosis severity and aggregate plaque burden. Published by Elsevier on behalf of the American College of Cardiology Foundation.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available