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Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study

Authors
 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  ;  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 
Citation
 INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING, Vol.36(12) : 2357-2364, 2020-12 
Journal Title
 INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 
ISSN
 1569-5794 
Issue Date
2020-12
MeSH
Aged ; Computed Tomography Angiography* ; Coronary Angiography* ; Coronary Artery Disease / diagnostic imaging* ; Coronary Stenosis / diagnostic imaging* ; Coronary Vessels / diagnostic imaging* ; Disease Progression ; Female ; Heart Disease Risk Factors ; Humans ; Male ; Middle Aged ; Plaque, Atherosclerotic* ; Predictive Value of Tests ; Prospective Studies ; Registries ; Risk Assessment ; Rupture, Spontaneous ; Time Factors
Keywords
Coronary artery atherosclerosis ; Coronary artery disease ; Coronary computed tomography angiography ; Statins
Abstract
To determine whether the assessment of individual plaques is superior in predicting the progression to obstructive coronary artery disease (CAD) on serial coronary computed tomography angiography (CCTA) than per-patient assessment. From a multinational registry of 2252 patients who underwent serial CCTA at a ≥ 2-year inter-scan interval, patients with only non-obstructive lesions at baseline were enrolled. CCTA was quantitatively analyzed at both the per-patient and per-lesion level. Models predicting the development of an obstructive lesion at follow up using either the per-patient or per-lesion level CCTA measures were constructed and compared. From 1297 patients (mean age 60 ± 9 years, 43% men) enrolled, a total of 3218 non-obstructive lesions were identified at baseline. At follow-up (inter-scan interval: 3.8 ± 1.6 years), 76 lesions (2.4%, 60 patients) became obstructive, defined as > 50% diameter stenosis. The C-statistics of Model 1, adjusted only by clinical risk factors, was 0.684. The addition of per-patient level total plaque volume (PV) and the presence of high-risk plaque (HRP) features to Model 1 improved the C-statistics to 0.825 [95% confidence interval (CI) 0.823-0.827]. When per-lesion level PV and the presence of HRP were added to Model 1, the predictive value of the model improved the C-statistics to 0.895 [95% CI 0.893-0.897]. The model utilizing per-lesion level CCTA measures was superior to the model utilizing per-patient level CCTA measures in predicting the development of an obstructive lesion (p < 0.001). Lesion-level analysis of coronary atherosclerotic plaques with CCTA yielded better predictive power for the development of obstructive CAD than the simple quantification of total coronary atherosclerotic burden at a per-patient level.Clinical Trial Registration: ClinicalTrials.gov NCT0280341.
Full Text
https://link.springer.com/article/10.1007/s10554-020-01960-z
DOI
10.1007/s10554-020-01960-z
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/181418
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