Progression of whole-heart Atherosclerosis by coronary CT and major adverse cardiovascular events
Authors
Alexander R van Rosendael ; Fay Y Lin ; Inge J van den Hoogen ; Xiaoyue Ma ; Umberto Gianni ; Omar Al Hussein Alawamlh ; Subhi J Al'Aref ; Jessica M Peña ; Daniele Andreini ; Matthew J Budoff ; Filippo Cademartiri ; Kavitha Chinnaiyan ; Jung Hyun Choi ; Edoardo Conte ; Hugo Marques ; Pedro de Araújo Gonçalves ; Ilan Gottlieb ; Martin Hadamitzky ; Jonathon Leipsic ; Erica Maffei ; Gianluca Pontone ; Gilbert L Raff ; Sanghoon Shin ; Yong-Jin Kim ; Byoung Kwon Lee ; Eun Ju Chun ; Ji Min Sung ; Sang-Eun Lee ; Donghee Han ; Daniel S Berman ; Renu Virmani ; Habib Samady ; Peter Stone ; Jagat Narula ; Jeroen J Bax ; Leslee J Shaw ; James K Min ; Hyuk-Jae Chang
Citation
JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY, Vol.15(4) : 322-330, 2021-07
Background: The current study aimed to examine the independent prognostic value of whole-heart atherosclerosis progression by serial coronary computed tomography angiography (CCTA) for major adverse cardiovascular events (MACE).
Methods: The multi-center PARADIGM study includes patients undergoing serial CCTA for symptomatic reasons, ≥2 years apart. Whole-heart atherosclerosis was characterized on a segmental level, with co-registration of baseline and follow-up CCTA, and summed to per-patient level. The independent prognostic significance of atherosclerosis progression for MACE (non-fatal myocardial infarction [MI], death, unplanned coronary revascularization) was examined. Patients experiencing interval MACE were not omitted.
Results: The study population comprised 1166 patients (age 60.5 ± 9.5 years, 54.7% male) who experienced 139 MACE events during 8.2 (IQR 6.2, 9.5) years of follow up (15 death, 5 non-fatal MI, 119 unplanned revascularizations). Whole-heart percent atheroma volume (PAV) increased from 2.32% at baseline to 4.04% at follow-up. Adjusted for baseline PAV, the annualized increase in PAV was independently associated with MACE: OR 1.23 (95% CI 1.08, 1.39) per 1 standard deviation increase, which was consistent in multiple subpopulations. When categorized by composition, only non-calcified plaque progression associated independently with MACE, while calcified plaque did not. Restricting to patients without events before follow-up CCTA, those with future MACE showed an annualized increase in PAV of 0.93% (IQR 0.34, 1.96) vs 0.32% (IQR 0.02, 0.90), P < 0.001.
Conclusions: Whole-heart atherosclerosis progression examined by serial CCTA is independently associated with MACE, with a prognostic threshold of 1.0% increase in PAV per year.