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Characteristics of atherosclerotic plaques evaluated at coronary computed tomography angiography associated with higher risk of future acute coronary syndrome: a long-term follow-up study

Session Best Posters session 6

Speaker Edoardo Conte

Event : ESC Congress 2015

  • Topic : imaging
  • Sub-topic : Computed Tomography
  • Session type : Best ePosters

Authors : E Conte (Milan,IT), S Mushtaq (Milan,IT), C Segurini (Milan,IT), M Guglielmo (Milan,IT), A Baggiano (Milan,IT), V Volpato (Milan,IT), A Annoni (Milan,IT), G Pontone (Milan,IT), M Pepi (Milan,IT), D Andreini (Milan,IT)

Authors:
E. Conte1 , S. Mushtaq1 , C. Segurini1 , M. Guglielmo1 , A. Baggiano1 , V. Volpato1 , A. Annoni1 , G. Pontone1 , M. Pepi1 , D. Andreini2 , 1Cardiology Center Monzino IRCCS - Milan - Italy , 2University of Milan, Department of Clinical Sciences and Community Health, Cardiovascular Section - Milan - Italy ,

Citation:
European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 891-892

Background: Obstructive coronary artery disease (CAD) is associated with higher cardiovascular events rate. Recent studies suggested that even non-obstructive plaques increase cardiovascular events rate at long-term follow-up. However, how to discriminate patients at higher risk for acute coronary syndrome (ACS) among patients with non-obstructive CAD is still unclear.

Purpose: Aim of our study is to identify plaque characteristics at coronary computed tomography angiography (CCTA) evaluation associated with high risk of ACS at long-term follow-up in a population of patients with non-obstructive CAD.

Methods: We enrolled 198 patients who underwent CCTA for suspected CAD in our center between April 2005 and December 2008 and who were found to have non-obstructive CAD. We evaluated coronary arterial remodeling index (RI) by using vessel diameter (RIdiam = lesion diameter/reference diameter) and vessel area (RIarea = lesion area/reference area), attenuation value of plaque (HU), stenosis severity (lesion lumen area/reference lumen area) and plaque burden (PB = lesion area/lesion lumen area) for each coronary plaque detected. Outcome measure was a composite of hard cardiac events (cardiac deaths, nonfatal myocardial infarctions and unstable angina).

Results: A long follow-up (mean 95±17 months) was obtained in 186 patients (93,3%). A total of 9 events were recorded (2 STEMI, 2 NSTEMI, 5 UA) in 9 different patients. Patients with and without events had similar HeartScore (median: 2,5% vs 2,4%, respectively; p=0.2855) and medications use (of particular interest ASA 55% vs 30% respectively, p=0.3252 and statin 33% vs 24% respectively, p=0.8321). Patients with ACS had higher degree of coronary artery stenosis (mean 38,5% vs 31,9%, respectively; p=0.0258), higher PB (median 0.52 vs 0.43, respectively; p=0.0120), higher RIarea (mean 1.58 vs 1.28; p=0.0006), higher RIdiam (median 1.45 vs 1.25 p=0.0001) and lower HU (median 163 vs 501 p=0.0368). At multivariate analysis only the presence of at least 2 segments with positive RIarea has been found to be significantly associated with ACS occurrence (HR 17.2 CI 95% 1.06–179; p=0.0178). Cumulative ACS-free survival was 98% for patient without positive RIarea plaque, 93% for those with one positive RIarea plaque and 79% for those with more than 2 positive RIarea plaque (log-rank p=0.0012).

Conclusions: CCTA plaque evaluation appears to have prognostic significance and positive remodeling index seems to be the most promising tool for risk stratification in patients with non-obstructive CAD, beyond coronary stenosis and traditional risk factors.

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