Coronary Artery Plaque Characteristics Associated With Adverse Outcomes in the SCOT-HEART Study

• Published in: Journal of the American College of Cardiology Vol. 73; no. 3; pp. 291 - 301
• Main Authors: Williams, Michelle C., Moss, Alastair J., Dweck, Marc, Adamson, Philip D., Alam, Shirjel, Hunter, Amanda, Shah, Anoop S.V., Pawade, Tania, Weir-McCall, Jonathan R., Roditi, Giles, van Beek, Edwin J.R., Newby, David E., Nicol, Edward D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 29.01.2019; Elsevier Limited; Elsevier Biomedical
• Subjects: Aged; Angina pectoris; Angiography; Arteriosclerosis; atherosclerotic plaque; Calcification; Calcification (ectopic); Calcinosis - diagnostic imaging; Calcium; Cardiology; Cardiovascular; Cardiovascular disease; Clinical trials; Computed tomography; Computed Tomography Angiography; coronary angiography; Coronary artery; Coronary artery disease; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Stenosis - etiology; Coronary vessels; Death; Family medical history; Female; Follow-Up Studies; Heart attacks; Heart diseases; Humans; Male; Medical imaging; Middle Aged; Myocardial infarction; Myocardial Infarction - etiology; Patients; Plaque, Atherosclerotic - complications; Plaque, Atherosclerotic - diagnostic imaging; Statistical analysis; Tomography; computed tomography; coronary artery disease; CT; CTA; AU; CI; HR; IQR; atherosclerotic plaque; coronary angiography; computed tomography angiography; interquartile range; Agatston units; hazard ratio; confidence interval
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2018.10.066

Unlike most noninvasive imaging modalities, coronary computed tomography angiography can characterize subtypes of atherosclerotic plaque. The purpose of this study was to investigate the prognostic implications of adverse coronary plaque characteristics in patients with suspected coronary artery disease. In this SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) post hoc analysis, the presence of adverse plaque (positive remodeling or low attenuation plaque), obstructive disease, and coronary artery calcification within 15 coronary segments was assessed on coronary computed tomography angiography of 1,769 patients who were followed-up for 5 years. Among study participants (mean age 58 ± 10 years; 56% male), 608 (34%) patients had 1 or more adverse plaque features. Coronary heart disease death or nonfatal myocardial infarction was 3 times more frequent in patients with adverse plaque (n = 25 of 608 [4.1%] vs. n = 16 of 1,161 [1.4%]; p < 0.001; hazard ratio [HR]: 3.01; 95% confidence interval (CI): 1.61 to 5.63; p = 0.001) and was twice as frequent in those with obstructive disease (n = 22 of 452 [4.9%] vs. n = 16 of 671 [2.4%]; p = 0.024; HR: 1.99; 95% CI: 1.05 to 3.79; p = 0.036). Patients with both obstructive disease and adverse plaque had the highest event rate, with a 10-fold increase in coronary heart disease death or nonfatal myocardial infarction compared with patients with normal coronary arteries (HR: 11.50; 95% CI: 3.39 to 39.04; p < 0.001). However, these associations were not independent of coronary artery calcium score, a surrogate measure of coronary plaque burden. Adverse coronary plaque characteristics and overall calcified plaque burden confer an increased risk of coronary heart disease death or nonfatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590) [Display omitted]