Characteristics of high-risk coronary plaques identified by computed tomographic angiography and associated prognosis: a systematic review and meta-analysis

Abstract

To clarify the potential role of coronary computed tomographic angiography (CCTA) in characterizing and prognosticating high-risk coronary plaques. A systematic review and meta-analysis were conducted to compare high-risk vs. low-risk plaques and culprit vs. non-culprit lesions in patients with acute coronary syndrome (ACS) vs. stable angina (SA). High-risk plaques were defined by at least one of the following features: non-calcified plaque (NCP), the presence of spotty calcified plaque (SCP), or increased remodelling index (RI). Results of included studies were pooled as odds ratios (OR) or weighted mean differences (WMD) with 95% confidence interval (CI). Eighteen eligible studies provided data to compare plaque types, plaque volume, and RI. Six studies provided data on ACS events in vulnerable high-risk vs. low-risk calcified plaques after 35 ± 2 months of follow-up. ACS patients had significantly higher number of NCP and SCP compared with SA patients with OR = 1.96 (1.47-2.60; 95% CI) P = 0.0001 and OR = 4.5 (2.98-6.83; 95% CI) P = 0.0001, respectively. Total plaque volume in ACS was not larger than SA: WMD = 22.9 (-22.1 to 67; 95% CI) mm(3), P = 0.32, but NCP volume was significantly larger: WMD = 28.8 (10.9-46.7; 95% CI) mm(3), P = 0.002. RI was higher in culprit lesions in ACS compared with SA and compared with non-culprit lesions in ACS patients: WMD = 0.48 (0.25-0.70; 95% CI) P = 0.0001 and 0.19 (0.07-0.30) P = 0.0001, respectively. The associated risk of future ACS was significantly higher in high-risk than in low-risk plaques: OR = 12.1 (5.24-28.1; 95% CI) P = 0.0001. CCTA can non-invasively characterize high-risk vulnerable coronary plaques and can predict future ACS events in patients with high-risk plaques.

Computed Tomography and Cardiac Magnetic Resonance in Ischemic Heart Disease

“…(33) studied 3,158 patients with coronary CTA and found high-risk lesions (defined by the presence of both positive remodeling and low-attenuation necrotic cores) in 294 patients who were subsequently 10 times more likely to experience ACS than patients without such plaque (16% event rate in patients with high-risk plaque compared with 1.4% event rate in those without). Similarly, a recent meta-analysis showed that the risk of future ACS was 12-fold higher (odds ratio: 12.1; 95% confidence interval [CI]: 5.2 to 28.1; p < 0.0001) in patients with high-risk lesions than in those with low-risk plaques (30). Although these data support adverse plaque detection as a means of identifying high-risk patients, confirmation in large-scale multicenter clinical trials is required.…”

“…Beyond this simple categorization, coronary CTA has demonstrated its ability to identify a range of adverse plaque characteristics, including positive remodeling, necrotic core, napkin ring sign, and spotty calcification (Figure 2) (30). Positive remodeling is defined by eccentric plaque formation with relative preservation of the lumen caliber.…”

Review. Automatic Segmentation Techniques of the Coronary Artery Using CT Images in Acute Coronary Syndromes

“…23 Also, the protrusion of the atheroma in the vessel lumen causes a shift from a normal, laminar flow, with evenly distributed transverse and shear stress, to a tur- 60 and microcalcification within the plaque (referred to as spotty calcifications). 61,62 CCTA is also able to evaluate the overall degree of calcification of the coronary tree by using the coronary artery calcium score, which has been shown to have a high predictive capacity for major adverse cardiovascular events, being combined with traditional cardiovascular risk factors (c-statistic of 0.93). luminal attenuation gradient through a coronary stenosis.…”

Assessment of Coronary Plaque Vulnerability in Acute Coronary Syndromes using Optical Coherence Tomography and Intravascular Ultrasound. A Systematic Review

“…[8][9][10][11][12] There may be associated active vascular remodeling, a process characterized by enlargement of the vessel diameter at the site of the plaque and the presence of spotty calcifications within the plaque. 9,13 invasive and noninvasive imaging techniques for Plaque characterization CCTA is currently the most common used technology for the noninvasive assessment of coronary atherosclerotic plaques. This technique has the unique ability to identify the presence of low-attenuation atheroma or napkinring sign within the plaque, described as a ring-shaped area with a low density upon CT examination, which is surrounded by a high-density attenuation.…”