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

49 Citations (Scopus)

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

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Acute Coronary Syndrome
Confidence Intervals
Coronary Artery Disease
Angiography
Pathologic Constriction
Case-Control Studies

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Coronary Atherosclerotic Precursors of Acute Coronary Syndromes. / Chang, Hyuk Jae; Lin, Fay Y.; Lee, Sang Eun; Andreini, Daniele; Bax, Jeroen; 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; Plank, Fabian; Pontone, Gianluca; Raff, Gilbert L.; van Rosendael, Alexander R.; 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; Berman, Daniel S.; Budoff, Matthew J.; Samady, Habib; Shaw, Leslee J.; Stone, Peter H.; Virmani, Renu; Narula, Jagat; Min, James K.

In: Journal of the American College of Cardiology, Vol. 71, No. 22, 05.06.2018, p. 2511-2522.

Research output: Contribution to journalArticle

Chang, HJ, Lin, FY, Lee, SE, Andreini, D, Bax, J, Cademartiri, F, Chinnaiyan, K, Chow, BJW, Conte, E, Cury, RC, Feuchtner, G, Hadamitzky, M, Kim, YJ, Leipsic, J, Maffei, E, Marques, H, Plank, F, Pontone, G, Raff, GL, van Rosendael, AR, Villines, TC, Weirich, HG, Al'Aref, SJ, Baskaran, L, Cho, I, Danad, I, Han, D, Heo, R, Lee, JH, Rivzi, A, Stuijfzand, WJ, Gransar, H, Lu, Y, Sung, JM, Park, HB, Berman, DS, Budoff, MJ, Samady, H, Shaw, LJ, Stone, PH, Virmani, R, Narula, J & Min, JK 2018, 'Coronary Atherosclerotic Precursors of Acute Coronary Syndromes', Journal of the American College of Cardiology, vol. 71, no. 22, pp. 2511-2522. https://doi.org/10.1016/j.jacc.2018.02.079
Chang, Hyuk Jae ; Lin, Fay Y. ; Lee, Sang Eun ; Andreini, Daniele ; Bax, Jeroen ; 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 ; Plank, Fabian ; Pontone, Gianluca ; Raff, Gilbert L. ; van Rosendael, Alexander R. ; 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 ; Berman, Daniel S. ; Budoff, Matthew J. ; Samady, Habib ; Shaw, Leslee J. ; Stone, Peter H. ; Virmani, Renu ; Narula, Jagat ; Min, James K. / Coronary Atherosclerotic Precursors of Acute Coronary Syndromes. In: Journal of the American College of Cardiology. 2018 ; Vol. 71, No. 22. pp. 2511-2522.
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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.",
keywords = "acute coronary syndrome, atherosclerosis, clinical outcome, coronary artery disease, coronary computed tomography angiography",
author = "Chang, {Hyuk Jae} and Lin, {Fay Y.} and Lee, {Sang Eun} and Daniele Andreini and Jeroen Bax and Filippo Cademartiri and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Edoardo Conte and Cury, {Ricardo C.} and Gudrun Feuchtner and Martin Hadamitzky and Kim, {Yong Jin} and Jonathon Leipsic and Erica Maffei and Hugo Marques and Fabian Plank and Gianluca Pontone and Raff, {Gilbert L.} and {van Rosendael}, {Alexander R.} and Villines, {Todd C.} and Weirich, {Harald G.} and Al'Aref, {Subhi J.} and Lohendran Baskaran and Iksung Cho and Ibrahim Danad and Donghee Han and Ran Heo and Lee, {Ji Hyun} and Asim Rivzi and Stuijfzand, {Wijnand J.} and Heidi Gransar and Yao Lu and Sung, {Ji Min} and Park, {Hyung Bok} and Berman, {Daniel S.} and Budoff, {Matthew J.} and Habib Samady and Shaw, {Leslee J.} and Stone, {Peter H.} and Renu Virmani and Jagat Narula and Min, {James K.}",
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doi = "10.1016/j.jacc.2018.02.079",
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TY - JOUR

T1 - Coronary Atherosclerotic Precursors of Acute Coronary Syndromes

AU - Chang, Hyuk Jae

AU - Lin, Fay Y.

AU - Lee, Sang Eun

AU - Andreini, Daniele

AU - Bax, Jeroen

AU - Cademartiri, Filippo

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin J.W.

AU - Conte, Edoardo

AU - Cury, Ricardo C.

AU - Feuchtner, Gudrun

AU - Hadamitzky, Martin

AU - Kim, Yong Jin

AU - Leipsic, Jonathon

AU - Maffei, Erica

AU - Marques, Hugo

AU - Plank, Fabian

AU - Pontone, Gianluca

AU - Raff, Gilbert L.

AU - van Rosendael, Alexander R.

AU - Villines, Todd C.

AU - Weirich, Harald G.

AU - Al'Aref, Subhi J.

AU - Baskaran, Lohendran

AU - Cho, Iksung

AU - Danad, Ibrahim

AU - Han, Donghee

AU - Heo, Ran

AU - Lee, Ji Hyun

AU - Rivzi, Asim

AU - Stuijfzand, Wijnand J.

AU - Gransar, Heidi

AU - Lu, Yao

AU - Sung, Ji Min

AU - Park, Hyung Bok

AU - Berman, Daniel S.

AU - Budoff, Matthew J.

AU - Samady, Habib

AU - Shaw, Leslee J.

AU - Stone, Peter H.

AU - Virmani, Renu

AU - Narula, Jagat

AU - Min, James K.

PY - 2018/6/5

Y1 - 2018/6/5

N2 - 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.

AB - 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.

KW - acute coronary syndrome

KW - atherosclerosis

KW - clinical outcome

KW - coronary artery disease

KW - coronary computed tomography angiography

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