Coronary Atherosclerotic Precursors of Acute Coronary Syndromes

H.-J. Chang; F.Y. Lin; S.-E. Lee; D. Andreini; J. Bax; F. Cademartiri; K. Chinnaiyan; B.J.W. Chow; E. Conte; R.C. Cury; G. Feuchtner; M. Hadamitzky; Y.-J. Kim; J. Leipsic; E. Maffei; H. Marques; F. Plank; G. Pontone; G.L. Raff; A.R. van Rosendael; T.C. Villines; H.G. Weirich; S.J. Al'Aref; L. Baskaran; I. Cho; I. Danad; D. Han; R. Heo; J.H. Lee; A. Rivzi; W.J. Stuijfzand; H. Gransar; Y. Lu; J.M. Sung; H.-B. Park; D.S. Berman; M.J. Budoff; H. Samady; L.J. Shaw; P.H. Stone; R. Virmani; J. Narula; J.K. Min

doi:10.1016/j.jacc.2018.02.079

Coronary Atherosclerotic Precursors of Acute Coronary Syndromes

H.-J. Chang, F.Y. Lin, S.-E. Lee, D. Andreini, J. Bax, F. Cademartiri, K. Chinnaiyan, B.J.W. Chow, E. Conte, R.C. Cury, G. Feuchtner, M. Hadamitzky, Y.-J. Kim, J. Leipsic, E. Maffei, H. Marques, F. Plank, G. Pontone, G.L. Raff, A.R. van RosendaelT.C. Villines, H.G. Weirich, S.J. Al'Aref, L. Baskaran, I. Cho, I. Danad, D. Han, R. Heo, J.H. Lee, A. Rivzi, W.J. Stuijfzand, H. Gransar, Y. Lu, J.M. Sung, H.-B. Park, D.S. Berman, M.J. Budoff, H. Samady, L.J. Shaw, P.H. Stone, R. Virmani, J. Narula, J.K. Min

IRCCS SDN

Research output: Contribution to journal › Article › peer-review

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. © 2018

Original language	English
Pages (from-to)	2511-2522
Number of pages	12
Journal	Journal of the American College of Cardiology
Volume	71
Issue number	22
DOIs	https://doi.org/10.1016/j.jacc.2018.02.079
Publication status	Published - 2018

Keywords

acute coronary syndrome
atherosclerosis
clinical outcome
coronary artery disease
coronary computed tomography angiography
adult
age
Article
case control study
cohort analysis
computed tomographic angiography
controlled study
coronary artery atherosclerosis
coronary artery obstruction
disease association
disease classification
disease severity
follow up
gender
high risk patient
human
major clinical study
male
mouse
nonhuman
priority journal
risk factor

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10.1016/j.jacc.2018.02.079

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85047161744&doi=10.1016%2fj.jacc.2018.02.079&partnerID=40&md5=f0b292dd456e7c34f5074e297b4b8c60

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Chang, H-J., Lin, F. Y., Lee, S-E., Andreini, D., Bax, J., Cademartiri, F., Chinnaiyan, K., Chow, B. J. W., Conte, E., Cury, R. C., Feuchtner, G., Hadamitzky, M., Kim, Y-J., Leipsic, J., Maffei, E., Marques, H., Plank, F., Pontone, G., Raff, G. L., ... Min, J. K. (2018). Coronary Atherosclerotic Precursors of Acute Coronary Syndromes. Journal of the American College of Cardiology, 71(22), 2511-2522. https://doi.org/10.1016/j.jacc.2018.02.079

Coronary Atherosclerotic Precursors of Acute Coronary Syndromes. / Chang, H.-J.; Lin, F.Y.; Lee, S.-E.; Andreini, D.; Bax, J.; Cademartiri, F.; Chinnaiyan, K.; Chow, B.J.W.; Conte, E.; Cury, R.C.; Feuchtner, G.; Hadamitzky, M.; Kim, Y.-J.; Leipsic, J.; Maffei, E.; Marques, H.; Plank, F.; Pontone, G.; Raff, G.L.; van Rosendael, A.R.; Villines, T.C.; Weirich, H.G.; Al'Aref, S.J.; Baskaran, L.; Cho, I.; Danad, I.; Han, D.; Heo, R.; Lee, J.H.; Rivzi, A.; Stuijfzand, W.J.; Gransar, H.; Lu, Y.; Sung, J.M.; Park, H.-B.; Berman, D.S.; Budoff, M.J.; Samady, H.; Shaw, L.J.; Stone, P.H.; Virmani, R.; Narula, J.; Min, J.K.

In: Journal of the American College of Cardiology, Vol. 71, No. 22, 2018, p. 2511-2522.

Research output: Contribution to journal › Article › peer-review

Chang, H-J, Lin, FY, Lee, S-E, Andreini, D, Bax, J, Cademartiri, F, Chinnaiyan, K, Chow, BJW, Conte, E, Cury, RC, Feuchtner, G, Hadamitzky, M, Kim, Y-J, 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, H-B, 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, H.-J. ; Lin, F.Y. ; Lee, S.-E. ; Andreini, D. ; Bax, J. ; Cademartiri, F. ; Chinnaiyan, K. ; Chow, B.J.W. ; Conte, E. ; Cury, R.C. ; Feuchtner, G. ; Hadamitzky, M. ; Kim, Y.-J. ; Leipsic, J. ; Maffei, E. ; Marques, H. ; Plank, F. ; Pontone, G. ; Raff, G.L. ; van Rosendael, A.R. ; Villines, T.C. ; Weirich, H.G. ; Al'Aref, S.J. ; Baskaran, L. ; Cho, I. ; Danad, I. ; Han, D. ; Heo, R. ; Lee, J.H. ; Rivzi, A. ; Stuijfzand, W.J. ; Gransar, H. ; Lu, Y. ; Sung, J.M. ; Park, H.-B. ; Berman, D.S. ; Budoff, M.J. ; Samady, H. ; Shaw, L.J. ; Stone, P.H. ; Virmani, R. ; Narula, J. ; Min, J.K. / Coronary Atherosclerotic Precursors of Acute Coronary Syndromes. In: Journal of the American College of Cardiology. 2018 ; Vol. 71, No. 22. pp. 2511-2522.

@article{23475fee5f61443dacb3b937a841c72f,

title = "Coronary Atherosclerotic Precursors of Acute Coronary Syndromes",

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. {\textcopyright} 2018",

keywords = "acute coronary syndrome, atherosclerosis, clinical outcome, coronary artery disease, coronary computed tomography angiography, adult, age, Article, case control study, cohort analysis, computed tomographic angiography, controlled study, coronary artery atherosclerosis, coronary artery obstruction, disease association, disease classification, disease severity, follow up, gender, high risk patient, human, major clinical study, male, mouse, nonhuman, priority journal, risk factor",

author = "H.-J. Chang and F.Y. Lin and S.-E. Lee and D. Andreini and J. Bax and F. Cademartiri and K. Chinnaiyan and B.J.W. Chow and E. Conte and R.C. Cury and G. Feuchtner and M. Hadamitzky and Y.-J. Kim and J. Leipsic and E. Maffei and H. Marques and F. Plank and G. Pontone and G.L. Raff and {van Rosendael}, A.R. and T.C. Villines and H.G. Weirich and S.J. Al'Aref and L. Baskaran and I. Cho and I. Danad and D. Han and R. Heo and J.H. Lee and A. Rivzi and W.J. Stuijfzand and H. Gransar and Y. Lu and J.M. Sung and H.-B. Park and D.S. Berman and M.J. Budoff and H. Samady and L.J. Shaw and P.H. Stone and R. Virmani and J. Narula and J.K. Min",

note = "Cited By :15 Export Date: 1 February 2019 CODEN: JACCD Correspondence Address: Min, J.K.; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, 413 East 69th Street, Suite 108, United States; email: jkm2001@med.cornell.edu References: Schoenhagen, P., Ziada, K.M., Kapadia, S.R., Crowe, T.D., Nissen, S.E., Tuzcu, E.M., Extent and direction of arterial remodeling in stable versus unstable coronary syndromes (2000) Circulation, 101, pp. 598-603; Virmani, R., Burke, A.P., Farb, A., Kolodgie, F.D., Pathology of the vulnerable plaque (2006) J Am Coll Cardiol, 47, pp. C13-C18; Yamagishi, M., Terashima, M., Awano, K., Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome (2000) J Am Coll Cardiol, 35, pp. 106-111; Motoyama, S., Sarai, M., Harigaya, H., Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome (2009) J Am Coll Cardiol, 54, pp. 49-57; Stone, G.W., Maehara, A., Lansky, A.J., A prospective natural-history study of coronary atherosclerosis (2011) N Engl J Med, 364, pp. 226-235; Ehara, S., Kobayashi, Y., Yoshiyama, M., Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: an intravascular ultrasound study (2004) Circulation, 110, pp. 3424-3429; Arbab-Zadeh, A., Fuster, V., The myth of the “vulnerable plaque”: transitioning from a focus on individual lesions to atherosclerotic disease burden for coronary artery disease risk assessment (2015) J Am Coll Cardiol, 65, pp. 846-855; Budoff, M.J., Dowe, D., Jollis, J.G., Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial (2008) J Am Coll Cardiol, 52, pp. 1724-1732; Motoyama, S., Ito, H., Sarai, M., Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up (2015) J Am Coll Cardiol, 66, pp. 337-346; Puchner, S.B., Liu, T., Mayrhofer, T., High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial (2014) J Am Coll Cardiol, 64, pp. 684-692; Hoffmann, U., Moselewski, F., Nieman, K., Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography (2006) J Am Coll Cardiol, 47, pp. 1655-1662; Leipsic, J., Abbara, S., Achenbach, S., SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee (2014) J Cardiovasc Comput Tomogr, 8, pp. 342-358; Min, J.K., Dunning, A., Lin, F.Y., Rationale and design of the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry (2011) J Cardiovasc Comput Tomogr, 5, pp. 84-92; Mendis, S., Thygesen, K., Kuulasmaa, K., World Health Organization definition of myocardial infarction: 2008-09 revision (2011) Int J Epidemiol, 40, pp. 139-146; Austin, P.C., An introduction to propensity score methods for reducing the effects of confounding in observational studies (2011) Multivariate Behav Res, 46, pp. 399-424; Thygesen, K., Alpert, J.S., Jaffe, A.S., Third universal definition of myocardial infarction (2012) Eur Heart J, 33, pp. 2551-2567; Abbara, S., Blanke, P., Maroules, C.D., SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee: endorsed by the North American Society for Cardiovascular Imaging (NASCI) (2016) J Cardiovasc Comput Tomogr, 10, pp. 435-449; Park, H.-B., Lee, B.K., Shin, S., Clinical feasibility of 3D automated coronary atherosclerotic plaque quantification algorithm on coronary computed tomography angiography: comparison with intravascular ultrasound (2015) Eur Radiol, 25, pp. 3073-3083; de Graaf, M.A., Broersen, A., Kitslaar, P.H., Automatic quantification and characterization of coronary atherosclerosis with computed tomography coronary angiography: cross-correlation with intravascular ultrasound virtual histology (2013) Int J Cardiovasc Imaging, 29, pp. 1177-1190; Fihn, S.D., Gardin, J.M., Abrams, J., 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons (2012) J Am Coll Cardiol, 60, pp. e44-e164; Austin, P.C., The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments (2014) Stat Med, 33, pp. 1242-1258; Lin, D.Y., Wei, L.J., The robust inference for the Cox proportional hazards model (1989) J Am Stat Assoc, 84, pp. 1074-1078; Wei, L.J., Lin, D.Y., Weissfeld, L., Regression analysis of multivariate incomplete failure time data by modeling marginal distributions (1989) J Am Stat Assoc, 84, pp. 1065-1073; Libby, P., Pasterkamp, G., Requiem for the {\textquoteleft}vulnerable plaque.{\textquoteright} (2015) Eur Heart J, p. ehv349; Maddox, T.M., Stanislawski, M.A., Grunwald, G.K., Nonobstructive coronary artery disease and risk of myocardial infarction (2014) JAMA, 312, pp. 1754-1763; Ambrose, J.A., Tannenbaum, M.A., Alexopoulos, D., Angiographic progression of coronary artery disease and the development of myocardial infarction (1988) J Am Coll Cardiol, 12, pp. 56-62; Tian, J., Ren, X., Vergallo, R., Distinct morphological features of ruptured culprit plaque for acute coronary events compared to those with silent rupture and thin-cap fibroatheroma: a combined optical coherence tomography and intravascular ultrasound study (2014) J Am Coll Cardiol, 63, pp. 2209-2216; Maurovich-Horvat, P., Hoffmann, U., Vorpahl, M., Nakano, M., Virmani, R., Alkadhi, H., The napkin-ring sign: CT signature of high-risk coronary plaques? (2010) J Am Coll Cardiol Img, 3, pp. 440-444; Nakazato, R., Otake, H., Konishi, A., Atherosclerotic plaque characterization by CT angiography for identification of high-risk coronary artery lesions: a comparison to optical coherence tomography (2015) Eur Heart J Cardiovasc Imaging, 16, pp. 373-379; Boogers, M.J., Broersen, A., van Velzen, J.E., Automated quantification of coronary plaque with computed tomography: comparison with intravascular ultrasound using a dedicated registration algorithm for fusion-based quantification (2012) Eur Heart J, 33, pp. 1007-1016; Puri, R., Nicholls, S.J., Shao, M., Impact of statins on serial coronary calcification during atheroma progression and regression (2015) J Am Coll Cardiol, 65, pp. 1273-1282",

year = "2018",

doi = "10.1016/j.jacc.2018.02.079",

language = "English",

volume = "71",

pages = "2511--2522",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "22",

}

TY - JOUR

T1 - Coronary Atherosclerotic Precursors of Acute Coronary Syndromes

AU - Chang, H.-J.

AU - Lin, F.Y.

AU - Lee, S.-E.

AU - Andreini, D.

AU - Bax, J.

AU - Cademartiri, F.

AU - Chinnaiyan, K.

AU - Chow, B.J.W.

AU - Conte, E.

AU - Cury, R.C.

AU - Feuchtner, G.

AU - Hadamitzky, M.

AU - Kim, Y.-J.

AU - Leipsic, J.

AU - Maffei, E.

AU - Marques, H.

AU - Plank, F.

AU - Pontone, G.

AU - Raff, G.L.

AU - van Rosendael, A.R.

AU - Villines, T.C.

AU - Weirich, H.G.

AU - Al'Aref, S.J.

AU - Baskaran, L.

AU - Cho, I.

AU - Danad, I.

AU - Han, D.

AU - Heo, R.

AU - Lee, J.H.

AU - Rivzi, A.

AU - Stuijfzand, W.J.

AU - Gransar, H.

AU - Lu, Y.

AU - Sung, J.M.

AU - Park, H.-B.

AU - Berman, D.S.

AU - Budoff, M.J.

AU - Samady, H.

AU - Shaw, L.J.

AU - Stone, P.H.

AU - Virmani, R.

AU - Narula, J.

AU - Min, J.K.

N1 - Cited By :15 Export Date: 1 February 2019 CODEN: JACCD Correspondence Address: Min, J.K.; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, 413 East 69th Street, Suite 108, United States; email: jkm2001@med.cornell.edu References: Schoenhagen, P., Ziada, K.M., Kapadia, S.R., Crowe, T.D., Nissen, S.E., Tuzcu, E.M., Extent and direction of arterial remodeling in stable versus unstable coronary syndromes (2000) Circulation, 101, pp. 598-603; Virmani, R., Burke, A.P., Farb, A., Kolodgie, F.D., Pathology of the vulnerable plaque (2006) J Am Coll Cardiol, 47, pp. C13-C18; Yamagishi, M., Terashima, M., Awano, K., Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome (2000) J Am Coll Cardiol, 35, pp. 106-111; Motoyama, S., Sarai, M., Harigaya, H., Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome (2009) J Am Coll Cardiol, 54, pp. 49-57; Stone, G.W., Maehara, A., Lansky, A.J., A prospective natural-history study of coronary atherosclerosis (2011) N Engl J Med, 364, pp. 226-235; Ehara, S., Kobayashi, Y., Yoshiyama, M., Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: an intravascular ultrasound study (2004) Circulation, 110, pp. 3424-3429; Arbab-Zadeh, A., Fuster, V., The myth of the “vulnerable plaque”: transitioning from a focus on individual lesions to atherosclerotic disease burden for coronary artery disease risk assessment (2015) J Am Coll Cardiol, 65, pp. 846-855; Budoff, M.J., Dowe, D., Jollis, J.G., Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial (2008) J Am Coll Cardiol, 52, pp. 1724-1732; Motoyama, S., Ito, H., Sarai, M., Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up (2015) J Am Coll Cardiol, 66, pp. 337-346; Puchner, S.B., Liu, T., Mayrhofer, T., High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial (2014) J Am Coll Cardiol, 64, pp. 684-692; Hoffmann, U., Moselewski, F., Nieman, K., Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography (2006) J Am Coll Cardiol, 47, pp. 1655-1662; Leipsic, J., Abbara, S., Achenbach, S., SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee (2014) J Cardiovasc Comput Tomogr, 8, pp. 342-358; Min, J.K., Dunning, A., Lin, F.Y., Rationale and design of the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry (2011) J Cardiovasc Comput Tomogr, 5, pp. 84-92; Mendis, S., Thygesen, K., Kuulasmaa, K., World Health Organization definition of myocardial infarction: 2008-09 revision (2011) Int J Epidemiol, 40, pp. 139-146; Austin, P.C., An introduction to propensity score methods for reducing the effects of confounding in observational studies (2011) Multivariate Behav Res, 46, pp. 399-424; Thygesen, K., Alpert, J.S., Jaffe, A.S., Third universal definition of myocardial infarction (2012) Eur Heart J, 33, pp. 2551-2567; Abbara, S., Blanke, P., Maroules, C.D., SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee: endorsed by the North American Society for Cardiovascular Imaging (NASCI) (2016) J Cardiovasc Comput Tomogr, 10, pp. 435-449; Park, H.-B., Lee, B.K., Shin, S., Clinical feasibility of 3D automated coronary atherosclerotic plaque quantification algorithm on coronary computed tomography angiography: comparison with intravascular ultrasound (2015) Eur Radiol, 25, pp. 3073-3083; de Graaf, M.A., Broersen, A., Kitslaar, P.H., Automatic quantification and characterization of coronary atherosclerosis with computed tomography coronary angiography: cross-correlation with intravascular ultrasound virtual histology (2013) Int J Cardiovasc Imaging, 29, pp. 1177-1190; Fihn, S.D., Gardin, J.M., Abrams, J., 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons (2012) J Am Coll Cardiol, 60, pp. e44-e164; Austin, P.C., The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments (2014) Stat Med, 33, pp. 1242-1258; Lin, D.Y., Wei, L.J., The robust inference for the Cox proportional hazards model (1989) J Am Stat Assoc, 84, pp. 1074-1078; Wei, L.J., Lin, D.Y., Weissfeld, L., Regression analysis of multivariate incomplete failure time data by modeling marginal distributions (1989) J Am Stat Assoc, 84, pp. 1065-1073; Libby, P., Pasterkamp, G., Requiem for the ‘vulnerable plaque.’ (2015) Eur Heart J, p. ehv349; Maddox, T.M., Stanislawski, M.A., Grunwald, G.K., Nonobstructive coronary artery disease and risk of myocardial infarction (2014) JAMA, 312, pp. 1754-1763; Ambrose, J.A., Tannenbaum, M.A., Alexopoulos, D., Angiographic progression of coronary artery disease and the development of myocardial infarction (1988) J Am Coll Cardiol, 12, pp. 56-62; Tian, J., Ren, X., Vergallo, R., Distinct morphological features of ruptured culprit plaque for acute coronary events compared to those with silent rupture and thin-cap fibroatheroma: a combined optical coherence tomography and intravascular ultrasound study (2014) J Am Coll Cardiol, 63, pp. 2209-2216; Maurovich-Horvat, P., Hoffmann, U., Vorpahl, M., Nakano, M., Virmani, R., Alkadhi, H., The napkin-ring sign: CT signature of high-risk coronary plaques? (2010) J Am Coll Cardiol Img, 3, pp. 440-444; Nakazato, R., Otake, H., Konishi, A., Atherosclerotic plaque characterization by CT angiography for identification of high-risk coronary artery lesions: a comparison to optical coherence tomography (2015) Eur Heart J Cardiovasc Imaging, 16, pp. 373-379; Boogers, M.J., Broersen, A., van Velzen, J.E., Automated quantification of coronary plaque with computed tomography: comparison with intravascular ultrasound using a dedicated registration algorithm for fusion-based quantification (2012) Eur Heart J, 33, pp. 1007-1016; Puri, R., Nicholls, S.J., Shao, M., Impact of statins on serial coronary calcification during atheroma progression and regression (2015) J Am Coll Cardiol, 65, pp. 1273-1282

PY - 2018

Y1 - 2018

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. © 2018

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. © 2018

KW - acute coronary syndrome

KW - atherosclerosis

KW - clinical outcome

KW - coronary artery disease

KW - coronary computed tomography angiography

KW - adult

KW - age

KW - Article

KW - case control study

KW - cohort analysis

KW - computed tomographic angiography

KW - controlled study

KW - coronary artery atherosclerosis

KW - coronary artery obstruction

KW - disease association

KW - disease classification

KW - disease severity

KW - follow up

KW - gender

KW - high risk patient

KW - human

KW - major clinical study

KW - male

KW - mouse

KW - nonhuman

KW - priority journal

KW - risk factor

U2 - 10.1016/j.jacc.2018.02.079

DO - 10.1016/j.jacc.2018.02.079

M3 - Article

VL - 71

SP - 2511

EP - 2522

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 22

ER -

Coronary Atherosclerotic Precursors of Acute Coronary Syndromes

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