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Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes With CCTA

 Sang-Eun Lee  ;  Ji Min Sung  ;  Daniele Andreini  ;  Mouaz H Al-Mallah  ;  Matthew J Budoff  ;  Filippo Cademartiri  ;  Kavitha Chinnaiyan  ;  Jung Hyun Choi  ;  Eun Ju Chun  ;  Edoardo Conte  ;  Ilan Gottlieb  ;  Martin Hadamitzky  ;  Yong Jin Kim  ;  Byoung Kwon Lee  ;  Jonathon A Leipsic  ;  Erica Maffei  ;  Hugo Marques  ;  Pedro de Araújo Gonçalves  ;  Gianluca Pontone  ;  Gilbert L Raff  ;  Sanghoon Shin  ;  Peter H Stone  ;  Habib Samady  ;  Renu Virmani  ;  Jagat Narula  ;  Daniel S Berman  ;  Leslee J Shaw  ;  Jeroen J Bax  ;  Fay Y Lin  ;  James K Min  ;  Hyuk-Jae Chang 
 JACC-CARDIOVASCULAR IMAGING, Vol.13(6) : 1409-1417, 2020-06 
Journal Title
Issue Date
coronary artery atherosclerosis ; coronary artery disease ; coronary computed tomography angiography ; high-risk plaque
Objectives: This study explored whether the pattern of nonobstructive lesion progression into obstructive lesions would differ according to the presence of high-risk plaque (HRP). Background: It is still debatable whether HRP simply represents a certain phase during the natural history of coronary atherosclerotic plaques or if disease progression would differ according to the presence of HRP. Methods: Patients with nonobstructive coronary artery disease, defined as percent diameter stenosis (%DS) <50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. HRP was defined as lesions with ≥2 features of positive remodeling, spotty calcification, or low-attenuation plaque. Quantitative total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions. Results: A total of 3,049 nonobstructive lesions were identified from 1,297 patients (mean age 60.3 ± 9.3 years; 56.8% men). There were 2,624 non-HRP and 425 HRP lesions. HRP lesions had a greater total PAV and all noncalcified components of PAV and %DS at baseline compared with non-HRP lesions. However, the annualized total PAV changes were greater in non-HRP lesions than in HRP lesions. On multivariate analysis adjusted for clinical risk factors, drug use, change in lipid level, total PAV, %DS, and HRP, only the baseline total PAV and %DS independently predicted the development of obstructive lesions (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02 to 1.07, and HR: 1.07; 95% CI: 1.04 to 1.10, respectively, all p < 0.05), whereas the presence of HRP did not (p > 0.05). Conclusions: The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV, not the presence of HRP features, was the most important predictor of lesions developing into obstructive lesions. (Progression of Atherosclerotic Plaque Determined By Computed Tomographic Angiography Imaging [PARADIGM]; NCT02803411).
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Sung, Ji Min(성지민)
Lee, Byoung Kwon(이병권) ORCID logo https://orcid.org/0000-0001-9259-2776
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
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