Association Of Coronary Atherosclerosis Progression Evaluated By Coronary CT Angiography With Cardiac Events

Part I Association of Coronary Atherosclerosis Progression and Cardiac Events:Evaluation by CT Angiography in Patients with Suspected Coronary Artery Disease Objectives:Little is known about the influence of coronary atherosclerosis progression on the risk of major adverse cardiac events(MACE).Similarly,differences between men and women regarding atherosclerosis progression are poorly understood.We sought to investigate coronary atherosclerosis progression of coronary atherosclerosis by coronary CT angiography(CCTA)in men and women and demonstrate its predictive value of MACE.Materials and Methods:Total 953 patients with suspected coronary atherosclerosis disease(CAD)underwent serial CCTA due to new or worsening symptoms after baseline CCTA were enrolled.Coronary atherosclerosis were semi-quantitatively assessed as following:1)obstructive plaque scores(three-vessel plaque score(TVPS)and severe proximal plaque score(SPPS));2)scores exhibiting plaque distribution and extent(segment stenosis score(SSS)and segment involvement score(SIS));3)coronary artery calcium score(CACS).Patients were followed-up regarding the occurrence of MACE,defined as cardiac death,coronary revascularization,nonfatal myocardial infarction and hospitalization due to unstable angina.Follow-up information was gathered by clinical visits or telephone contacts.Results:Follow-up was achieved in 953(91.1%)patients(63.8%male;mean age,53.9 ±9.7 years).The mean patient follow-up period was 4.9±1.1 years.MACE occurred in 132(13.9%)patients.Patients who suffered MACE had significantly(P<0.001)greater plaque progression than those without MACE.There was a strong association between progression of SPPS(HR = 2.63,P = 0.004)and SSS(HR = 1.37,P = 0.023)and MACE.There were no statistically significant associations between the progression of TVPS,SIS,or CACS and incidence of MACE(P>0.05).Compared with women,men had significantly higher progression of SPPS,SSS and SIS(6.6%vs.3.5%,28.0%vs.18.3%.26.6%vs.16.8%,respectively,all P<0.05).There was a strong association between progression of SPPS as well as SSS and MACE,both for men(SPPS,HR=2.17,P<0.001;SSS,HR= 1.28,P =0.023)and women(SPPS,HR=2.75,P<0.001;SSS,HR=1.19,P = 0.027).Conclusion:Coronary atherosclerosis progression as determined by CCTA is associated with the risk of future MACE.Progression of coronary atherosclerosis as determined by CCTA is higher in men and women.It might aid in risk stratification and management of patients with CAD.Part ? Prognostic value of coronary atherosclerosis progression evaluated by coronary CT angiography in patients with stable anginaObjectives:To investigate the progression of coronary atherosclerosis burden by coronary CT angiography(CCTA)and to demonstrate its association with the incidence of major adverse cardiac events(MACE).Materials and Methods:We retrospectively studied patients with stable angina who had undergone repeat CCTA due to recurrent or worsening symptoms.Lipid-rich,fibrous,calcified and total plaque burden,as well as coronary diameter stenosis were quantitatively analyzed.The incidence of MACE during follow-up was determined.Results:The final cohort consisted of 268 patients(mean age 52.9 ± 9.8 years,71%male)with a mean follow-up period of 4.6 ± 0.9 years.Patients with lipid-rich,fibrous,calcified,and total plaque burden(%)progression,as well as coronary diameter stenosis(%)progression had a significantly higher incidence of MACE than those without(all P<0.05).The progression of lipid-rich plaque(HR = 1.601,P = 0.021),total plaque burden(HR=2.979,P = 0.043)and coronary diameter stenosis(HR = 4.327,P<0.001)were independent predictors of MACE(all P<0.05).Conclusions:Patients presenting with recurrent or worsening symptoms associated with coronary artery disease who have coronary atherosclerosis progression on CCTA are at an increased risk of future MACE.