Coronary Atherosclerotic Precursors of Acute Coronary Syndromes

Hyuk Jae Chang, Fay Y. Lin, Sang Eun Lee, Daniele Andreini, Jeroen Bax, Filippo Cademartiri, Kavitha Chinnaiyan, Benjamin J.W. Chow, Edoardo Conte, Ricardo C. Cury, Gudrun Feuchtner, Martin Hadamitzky, Yong Jin Kim, Jonathon Leipsic, Erica Maffei, Hugo Marques, Fabian Plank, Gianluca Pontone, Gilbert L. Raff, Alexander R. van RosendaelTodd C. Villines, Harald G. Weirich, Subhi J. Al'Aref, Lohendran Baskaran, Iksung Cho, Ibrahim Danad, Donghee Han, Ran Heo, Ji Hyun Lee, Asim Rivzi, Wijnand J. Stuijfzand, Heidi Gransar, Yao Lu, Ji Min Sung, Hyung Bok Park, Daniel S. Berman, Matthew J. Budoff, Habib Samady, Leslee J. Shaw, Peter H. Stone, Renu Virmani, Jagat Narula, James K. Min

Research output: Contribution to journalArticle

Abstract

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 mm3 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.

Original languageEnglish
Pages (from-to)2511-2522
Number of pages12
JournalJournal of the American College of Cardiology
Volume71
Issue number22
DOIs
Publication statusPublished - Jun 5 2018

Keywords

  • acute coronary syndrome
  • atherosclerosis
  • clinical outcome
  • coronary artery disease
  • coronary computed tomography angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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