Added Value of CCTA-Derived Features to Predict MACEs in Stable Patients Undergoing Coronary Computed Tomography

Abstract

Clinical evidence has emphasized the importance of coronary plaques’ characteristics, rather than lumen stenosis, for the outcome of cardiovascular events. Coronary computed tomographic angiography (CCTA) has a well-established role as a non-invasive tool for assessing plaques. The aim of this study was to compare clinical characteristics and CCTA-derived information of stable patients with non-severe plaques in predicting major adverse cardiac events (MACEs) during follow-up. We retrospectively selected 371 patients (64% male) who underwent CCTA in our center from March 2016 to January 2021 with Coronary Artery Disease—Reporting and Data System (CAD-RADS) 0 to 3. Of those, 198 patients (53% male) had CAD-RADS 0 to 1. Among them, 183 (49%) had normal pericoronary fat attenuation index (pFAI), while 15 (60% male) had pFAI ≥ 70.1 Hounsfield unit (HU). The remaining 173 patients (76% male) had CAD-RADS 2 to 3 and were divided into patients with at least one low attenuation plaque (LAP) and patients without LAPs (n-LAP). Compared to n-LAP, patients with LAPs had higher pFAI (p = 0.005) and had more plaques than patients with n-LAP. Presence of LAPs was significantly higher in elderly (p < 0.001), males (p < 0.001) and patients with traditional risk factors (hypertension p = 0.0001, hyperlipemia p = 0.0003, smoking p = 0.0003, diabetes p = <0.0001, familiarity p = 0.0007). Among patients with CAD-RADS 0 to 1, the ones with pFAI ≥ 70.1 HU were more often hyperlipidemic (p = 0.05) and smokers (p = 0.007). Follow-up (25,4 months, range: 17.6–39.2 months) demonstrated that LAP and pFAI ≥ 70.1 significantly and independently (p = 0.04) predisposed to outcomes (overall mortality and interventional procedures). There is an added value of CCTA-derived features in stratifying cardiovascular risk in low- to intermediate-risk patients with non-severe, non-calcified coronary plaques. This is of utmost clinical relevance as it is possible to identify a subset of patients with increased risk who need strengthening in therapeutic management and closer follow-up even in the absence of severe CAD. Further studies are needed to evaluate the effect of medical treatments on pericoronary inflammation and plaque composition.

Coronary artery calcium score: we know where we are but not where we may be

“…CCTA has achieved the temporal and spatial resolution to be able to define the lumen of even distal segments of the coronary artery tree. For this reason, the use of NC-CCTA has become less prevalent with the development of new techniques [9] and recent studies have demonstrated the integration of plaque analysis tools and pericoronary fat inflammation (pFAI) as valuable additions to cardiovascular risk evaluation, allowing for better stratification of cardiac risk beyond the degree of anatomical CAD, even in nonsignificant plaques [10][11][12]. For example, pFAI was shown to have different temporal distributions in patients with acute myocardial infarction type 2 compared to those with myocardial infarction with non-obstructive coronary arteries [13,14].…”

Computed tomography and nuclear medicine for the assessment of coronary inflammation: clinical applications and perspectives

“…[9][10][11] Detailed visualization of plaque components has allowed the identification of high-risk and vulnerable plaque features, which has led to the improvement in the prognostic power of the techinque. [12][13][14] Nowadays, the applications of the fractional flow reserve derived from CT (FFR ct ) and the stress CT perfusion (CTP) Article à Andrea Igoren Guaricci and Danilo Neglia contributed equally as first authors.…”

“…As a consequence, current indications of CTA include a large spectrum of patients with suspected CAD 9–11 . Detailed visualization of plaque components has allowed the identification of high-risk and vulnerable plaque features, which has led to the improvement in the prognostic power of the techinque 12–14 . Nowadays, the applications of the fractional flow reserve derived from CT (FFR ct ) and the stress CT perfusion (CTP) allow the combination of anatomic and functional assessment of CAD with excellent diagnostic and prognostic accuracy (Fig.…”

Epicardial and Pericoronary Adipose Tissue, Coronary Inflammation, and Acute Coronary Syndromes

“…Coronary computed tomography angiography (CCTA) provides various tools with which to assess coronary artery disease, ranging from calcium scoring to coronary plaque analysis. These tools are utilized as comprehensive prognostic indicators (based on scores) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17].…”