Total coronary atherosclerotic plaque burden is associated with myocardial ischemia in non-obstructive coronary artery disease

Aim: Whether the total coronary atherosclerotic plaque burden is independently associated with myocardial ischemia in non-obstructive coronary artery disease (CAD) is not well established. We aimed to test the association of total plaque burden quantified by coronary computed tomography angiography (CCTA) with myocardial ischemia in patients with chronic coronary syndrome and non-obstructive CAD. Methods: We included 125 patients (age 62 +/- 9 years, 58% women) with chronic coronary syndrome and non-obstructive CAD (stenosis < 50%) by CCTA, who were grouped according to presence or absence of myocardial ischemia by myocardial contrast stress echocardiography. Total plaque burden was quantified by CCTA as the total plaque volume in the main coronary arteries, and positive remodelling was defined as remodelling index > 1.10. Results: Patients with myocardial ischemia (n = 66) had higher total plaque burden (847 +/- 245 mm(3) vs. 758 +/- 251 mm(3), p = 0.049) and higher left ventricular (LV) mass index (42.1 +/- 9.9 g/m(2.7) vs. 37.3 +/- 8.0 g/m(2.7), p = 0.004), while age, sex, prevalence of hypertension, diabetes, calcium score and positive remodelling did not differ between the groups (all p > 0.05). In multivariable regression analysis, total plaque burden remained associated with presence of myocardial ischemia (OR 1.02, 95% CI 1.00-1.04, p = 0.045) independent of age, sex, hypertension, diabetes, LV mass index, coronary calcium score and positive remodelling. Conclusion: Total coronary artery plaque burden by CCTA was independently associated with myocardial ischemia in patients with non-obstructive CAD. Whether plaque quantification is useful for clinical management of patients with non-obstructive CAD should be tested in prospective studies. (C) 2021 The Authors. Published by Elsevier B.V.

Automated summary

The total coronary artery plaque burden assessed by CCTA is independently associated with myocardial ischemia in patients with non-obstructive CAD, suggesting that quantification of plaque burden may be beneficial for clinical management in this patient population.