Coronary Atherosclerotic Precursors of Acute Coronary Syndromes
Authors
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 Rosendael ; Todd 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
Citation
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol.71(22) : 2511-2522, 2018
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 mm(3) fibrofatty plaque, 95% CI: 1.000 to 1.003; 1.593 per mm(3) 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.