Korean J Radiol.  2017 Jun;18(3):487-497. 10.3348/kjr.2017.18.3.487.

Characteristics Detected on Computed Tomography Angiography Predict Coronary Artery Plaque Progression in Non-Culprit Lesions

Affiliations
  • 1Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China. yundaichen@yeah.net
  • 2The School of Medicine, Nankai University, Tianjin 300071, China.
  • 3Department of Cardiology, Tianjin Chest Hospital, Tianjin 300000, China.
  • 4Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.

Abstract


OBJECTIVE
This study sought to determine whether variables detected on coronary computed tomography angiography (CCTA) would predict plaque progression in non-culprit lesions (NCL).
MATERIALS AND METHODS
In this single-center trial, we analyzed 103 consecutive patients who were undergoing CCTA and percutaneous coronary intervention (PCI) for culprit lesions. Follow-up CCTA was scheduled 12 months after the PCI, and all patients were followed for 3 years after their second CCTA examination. High-risk plaque features and epicardial adipose tissue (EAT) volume were assessed by CCTA. Each NCL stenosis grade was compared visually between two CCTA scans to detect plaque progression, and patients were stratified into two groups based on this. Logistic regression analysis was used to evaluate the factors that were independently associated with plaque progression in NCLs. Time-to-event curves were compared using the log-rank statistic.
RESULTS
Overall, 34 of 103 patients exhibited NCL plaque progression (33%). Logistic regression analyses showed that the NCL progression was associated with a history of ST-elevated myocardial infarction (odds ratio [OR] = 5.855, 95% confidence interval [CI] = 1.391-24.635, p = 0.016), follow-up low-density lipoprotein cholesterol level (OR = 6.832, 95% CI = 2.103-22.200, p = 0.001), baseline low-attenuation plaque (OR = 7.311, 95% CI = 1.242-43.028, p = 0.028) and EAT (OR = 1.015, 95% CI = 1.000-1.029, p = 0.044). Following the second CCTA examination, major adverse cardiac events (MACEs) were observed in 12 patients, and NCL plaque progression was significantly associated with future MACEs (log rank p = 0.006).
CONCLUSION
Noninvasive assessment of NCLs by CCTA has potential prognostic value.

Keyword

Non-culprit lesion; Plaque progression; Low attenuation plaque; Coronary artery; Epicardial adipose tissue; Coronary computed tomography angiography

MeSH Terms

Adipose Tissue/diagnostic imaging
Aged
Area Under Curve
Cholesterol, HDL/blood
Cholesterol, LDL/blood
*Computed Tomography Angiography
Coronary Artery Disease/*diagnostic imaging/mortality
Disease Progression
Female
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Odds Ratio
Percutaneous Coronary Intervention
Plaque, Atherosclerotic/*diagnostic imaging/pathology
Prognosis
ROC Curve
Risk Factors
Triglycerides/blood
Cholesterol, HDL
Cholesterol, LDL
Triglycerides

Figure

  • Fig. 1 Flow chart illustrating study population.CABG = coronary artery bypass grafting surgery, CAD = coronary artery disease, CCTA = coronary computed tomography angiography, MACE = major adverse cardiovascular event, PCI = percutaneous coronary intervention

  • Fig. 2 Assessment of plaque progression by CCTA.A, C. NCL in baseline MPR cross-section and luminal stenosis measurements. B, D. Same lesion at follow-up CCTA. CCTA = coronary computed tomography angiography, MPR = multiplanar reconstruction, NCL = non-culprit lesion

  • Fig. 3 Area under receiver operating characteristic curve was 0.794 for EAT volume alone (95% CI = 0.702–0.885, p < 0.0001).CI = confidence interval, EAT = epicardial adipose tissue

  • Fig. 4 Kaplan-Meier curves for MACE-free survivor during 3-year post-CCTA follow-up period.CCTA = coronary computed tomography angiography, MACE = major adverse cardiovascular event


Cited by  1 articles

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Ji Hun Kang, Dong Hwan Kim, Seong Ho Park, Jung Hwan Baek
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