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. 2017 May-Jun;18(3):487-497.
doi: 10.3348/kjr.2017.18.3.487. Epub 2017 Apr 3.

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

Yahang Tan  1   2 , Jia Zhou  1   3 , Ying Zhou  1   4 , Xiaobo Yang  1   2 , Junjie Yang  1 , Yundai Chen  1
Affiliations

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

Yahang Tan et al. Korean J Radiol. 2017 May-Jun.

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.

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

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Figures

Fig. 1
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
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
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
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
See this image and copyright information in PMC

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