Open Access

Quantified coronary total plaque volume from computed tomography angiography provides superior 10-year risk stratification

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Date: 13 August 2020
Journal: European Heart Journal - Cardiovascular Imaging , Volume 22 , Issue 3 , Pages 314 - 321
Authors: S. Deseive , M. Kupke , R. Straub , T. Stocker , A. Broersen , P. Kitslaar , S. Martinoff , S. Massberg , M. Hadamitzky , J. Hausleiter

ESC Journals

AbstractAims 

Automated coronary total plaque volume (TPV) quantification derived from coronary computed tomographic angiography (CTA) datasets provide exact and reliable assessment of calcified and non-calcified coronary atherosclerosis burden. The aim of this analysis was to investigate the long-term predictive value of TPV.

Methods and results 

TPV was quantified in 1577 patients undergoing coronary CTA and cardiovascular events were collected during 10.5 years (interquartile range 6.0–11.4) of follow-up. The study endpoint comprised cardiac death and acute coronary syndrome and occurred in 59 (3.7%) patients. Coronary TPV provided additive prognostic value over clinical risk assessed with the Morise Score and coronary artery disease severity (rise in C-index from 0.744 to 0.769, P = 0.03). A category-based reclassification approach combining the Morise Score and TPV revealed superior risk stratification (categorical net reclassification improvement: 0.48 with 95% CI 0.13–0.68, P < 0.001) and resulted in reclassification of 800 (51%) patients compared with the Morise Score alone. The 10-year risk for the study endpoint was 0.6% (95% CI 0–1.3) for patients classified as low risk (n = 807), 4.8% (95% CI 2.4–7.2) for patients at intermediate risk (n = 400), and 10.3% (95% CI 6.6–13.9) for patients at high risk (n = 370) using the combined reclassification approach.

Conclusion 

Quantification of TPV from coronary CTA permits an improved 10-year cardiovascular risk stratification.

About the contributors

Simon Deseive

Munich (University Hospital of Munich)

Role: Author

Maximilian Kupke

Role: Author

Ramona Straub

Role: Author