Abstract
Purpose
To provide comparative prognostic information of coronary atherosclerotic plaque volume and stenosis assessment in patients with suspected coronary artery disease (CAD).
Methods
We followed 372 patients with suspected or known CAD enrolled in the CORE320 study for 2 years after baseline 320-detector row cardiac CT scanning and invasive quantitative coronary angiography (QCA). CT images were analyzed for coronary calcium scanning (CACS), semi-automatically derived total percent atheroma volume (PAV), segment stenosis score (SSS), in addition to traditional stenosis assessment (≥ 50%) by CT and QCA for (1) 30-day revascularization and (2) major adverse cardiac events (MACE). Area under the receiver operating characteristic curve (AUC) was used to compare accuracy of risk prediction.
Results
Sixty percent of patients had obstructive CAD by QCA with 23% undergoing 30-day revascularization and 9% experiencing MACE at 2 years. Most late events (20/32) were revascularization procedures. Prediction of 30-day revascularization was modest (AUC range 0.67–0.78) but improved after excluding patients with known CAD (AUC range 0.73–0.86, p < 0.05 for all). Similarly, prediction of MACE improved after excluding patients with known CAD (AUC range 0.58–0.73 vs. 0.63–0.77). CT metrics of atherosclerosis burden performed overall similarly but stenosis assessment was superior for predicting 30-day revascularization.
Conclusions
Angiographic and coronary atherosclerotic plaque metrics perform only modestly well for predicting 30-day revascularization and 2-year MACE in high risk patients but improve after excluding patients with known CAD. Atherosclerotic plaque metrics did not yield incremental value over stenosis assessment for predicting events that predominantly consisted of revascularization procedures.
Clinical Trial Registration: NCT00934037.
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Funding
The sponsor of the CORE320 study, Canon (formerly Toshiba) Medical Systems Corporation, was not involved during any stage of the planning, design, data acquisition, data analysis, or manuscript preparation of this study.
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Dr. J.H.C. Reiber has a part-time appointment as Professor of Medical Imaging at the Leiden University Medical Center (LUMC) and is the CEO of Medis medical imaging systems, Leiden, the Netherlands. Dr. P. Kitslaar has a research appointment at the LUMC, Division of Image Processing (LKEB), Department of Radiology and is an employee of Medis, Leiden, the Netherlands. Drs. F. Rybicki and A. Arbab-Zadeh disclose their membership of the CORE320 steering committee. The CORE320 study was sponsored by Canon (formerlyToshiba) Medical Systems. Dr. George and Mrs. Vavere have joined AstraZeneca as employees since completion of this research but disclose no conflicts to this topic.
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Kishi, S., Magalhães, T.A., Cerci, R.J. et al. Comparative effectiveness of coronary artery stenosis and atherosclerotic plaque burden assessment for predicting 30-day revascularization and 2-year major adverse cardiac events. Int J Cardiovasc Imaging 36, 2365–2375 (2020). https://doi.org/10.1007/s10554-020-01851-3
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DOI: https://doi.org/10.1007/s10554-020-01851-3