Coronary Atherosclerotic Precursors of Acute Coronary Syndromes
Hyuk-Jae Chang, Fay Y Lin, Sang-Eun Lee, Daniele Andreini, Jeroen Bax, Filippo Cademartiri, Kavitha Chinnaiyan, Benjamin J W Chow, Edoardo Conte, Ricardo C Cury, Gudrun Feuchtner, Martin Hadamitzky, Yong-Jin Kim, Jonathon Leipsic, Erica Maffei, Hugo Marques, Fabian Plank, Gianluca Pontone, Gilbert L Raff, Alexander R van Rosendael, Todd C Villines, Harald G Weirich, Subhi J Al'Aref, Lohendran Baskaran, Iksung Cho, Ibrahim Danad, Donghee Han, Ran Heo, Ji Hyun Lee, Asim Rivzi, Wijnand J Stuijfzand, Heidi Gransar, Yao Lu, Ji Min Sung, Hyung-Bok Park, Daniel S Berman, Matthew J Budoff, Habib Samady, Leslee J Shaw, Peter H Stone, Renu Virmani, Jagat Narula, James K Min, Hyuk-Jae Chang, Fay Y Lin, Sang-Eun Lee, Daniele Andreini, Jeroen Bax, Filippo Cademartiri, Kavitha Chinnaiyan, Benjamin J W Chow, Edoardo Conte, Ricardo C Cury, Gudrun Feuchtner, Martin Hadamitzky, Yong-Jin Kim, Jonathon Leipsic, Erica Maffei, Hugo Marques, Fabian Plank, Gianluca Pontone, Gilbert L Raff, Alexander R van Rosendael, Todd C Villines, Harald G Weirich, Subhi J Al'Aref, Lohendran Baskaran, Iksung Cho, Ibrahim Danad, Donghee Han, Ran Heo, Ji Hyun Lee, Asim Rivzi, Wijnand J Stuijfzand, Heidi Gransar, Yao Lu, Ji Min Sung, Hyung-Bok Park, Daniel S Berman, Matthew J Budoff, Habib Samady, Leslee J Shaw, Peter H Stone, Renu Virmani, Jagat Narula, James K Min
Abstract
Background: The association of atherosclerotic features with first acute coronary syndromes (ACS) has not accounted for plaque burden.
Objectives: The purpose of this study was to identify atherosclerotic features associated with precursors of ACS.
Methods: We performed a nested case-control study within a cohort of 25,251 patients undergoing coronary computed tomographic angiography (CTA) with follow-up over 3.4 ± 2.1 years. Patients with ACS and nonevent patients with no prior coronary artery disease (CAD) were propensity matched 1:1 for risk factors and coronary CTA-evaluated obstructive (≥50%) CAD. Separate core laboratories performed blinded adjudication of ACS and culprit lesions and quantification of baseline coronary CTA for percent diameter stenosis (%DS), percent cross-sectional plaque burden (PB), plaque volumes (PVs) by composition (calcified, fibrous, fibrofatty, and necrotic core), and presence of high-risk plaques (HRPs).
Results: We identified 234 ACS and control pairs (age 62 years, 63% male). More than 65% of patients with ACS had nonobstructive CAD at baseline, and 52% had HRP. The %DS, cross-sectional PB, fibrofatty and necrotic core volume, and HRP increased the adjusted hazard ratio (HR) of ACS (1.010 per %DS, 95% confidence interval [CI]: 1.005 to 1.015; 1.008 per percent cross-sectional PB, 95% CI: 1.003 to 1.013; 1.002 per mm3 fibrofatty plaque, 95% CI: 1.000 to 1.003; 1.593 per mm3 necrotic core, 95% CI: 1.219 to 2.082; all p < 0.05). Of the 129 culprit lesion precursors identified by coronary CTA, three-fourths exhibited <50% stenosis and 31.0% exhibited HRP.
Conclusions: Although ACS increases with %DS, most precursors of ACS cases and culprit lesions are nonobstructive. Plaque evaluation, including HRP, PB, and plaque composition, identifies high-risk patients above and beyond stenosis severity and aggregate plaque burden.
Keywords: acute coronary syndrome; atherosclerosis; clinical outcome; coronary artery disease; coronary computed tomography angiography.
Conflict of interest statement
Disclosures/Conflicts: The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Dr. Chang receives funding from by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176); Dr. Min receives funding from the National Institutes of Health (Grant Nos. R01 HL111141, R01 HL115150, R01 118019, and U01 HL 105907), the Qatar National Priorities Research Program (Grant No. 09-370-3-089), and GE Healthcare. Dr. Min served as a consultant to HeartFlow, serves on the scientific advisory board of Arineta, and has an equity interest in MDDX. Dr. Bax receives unrestricted research grants from Biotronik, Medtronic, Boston Scientific and Edwards Lifesciences. Dr. Leipsic serves as a consultant and has stock options in HeartFlow and Circle Cardiovascular Imaging, and receives speaking fees from GE Healthcare. Dr. Budoff receives grant support from the National Institutes of Health and General Electric. Dr. Samady receives grant support from Phillips/Volcano and St. Jude Abbott/Medtronic/Gilead. Dr. Chow holds the Saul and Edna Goldfarb Chair in Cardiac Imaging Research and receives research support from CV Diagnostix and educational support from TeraRecon Inc. Dr. Pontone receives institutional research grants from GE Healthcare, HeartFlow, Medtronic, Bracco, and Bayer. Dr. Virmani has received institutional research support from 480 Biomedical, Abbott Vascular, ART, BioSensors International, Biotronik, Boston Scientific, Celonova, Claret Medical, Cook Medical, Cordis, Edwards Lifescience, Medtronic, MicroVention, OrbusNeich, ReCord, SINO Medical Technology, Spectranetics, Surmodics, Terumo Corporation, W.L. Gore and Xeltis. Dr. Virmani also receives honoraria from 480 Biomedical, Abbott Vascular, Boston Scientific, Cook Medical, Lutonix, Medtronic, Terumo Corporation, and W.L. Gore, and is a consultant for 480 Biomedical, Abbott Vascular, Medtronic, and W.L. Gore. All other authors have no conflicts of interest to disclose.
Published by Elsevier Inc.
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Source: PubMed