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Coronary Atherosclerotic Precursors of Acute Coronary Syndromes

 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 
 Journal of the American College of Cardiology, Vol.71(22) : 2511-2522, 2018 
Journal Title
 Journal of the American College of Cardiology 
Issue Date
acute coronary syndrome ; atherosclerosis ; clinical outcome ; coronary artery disease ; coronary computed tomography angiography
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Sang Eun(이상은) ORCID logo https://orcid.org/0000-0001-6645-4038
Chang, Hyuck Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
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