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Review
. 2021 Nov 1;36(6):769-775.
doi: 10.1097/HCO.0000000000000911.

Evaluation of coronary stenosis versus plaque burden for atherosclerotic cardiovascular disease risk assessment and management

Omar Dzaye  1 , Alexander C Razavi  1 , Michael J Blaha  1 , Martin Bødtker Mortensen  1   2
Affiliations
Review

Evaluation of coronary stenosis versus plaque burden for atherosclerotic cardiovascular disease risk assessment and management

Omar Dzaye et al. Curr Opin Cardiol. .

Abstract

Purpose of review: To provide a summary of recent literature on the relative impact of luminal stenosis versus atherosclerotic plaque burden in atherosclerotic cardiovascular disease (ASCVD) risk stratification and management.

Recent findings: Recent results from both randomized controlled clinical trials as well as observational cohort studies have demonstrated that ASCVD risk is mediated mainly by the extent of atherosclerotic disease burden rather than by the presence of coronary stenosis or inducible ischemia. Although patients with obstructive CAD are generally at higher risk for ASCVD events than patients with nonobstructive CAD, this is driven by a higher plaque burden in those with obstructive CAD. Accordingly, the ASCVD risk for a given plaque burden is similar in patients with and without obstructive CAD. Accompanying these observations are randomized controlled trial data, which show that optimization of medical therapy instead of early revascularization is most important for improving prognosis in patients with stable obstructive CAD.

Summary: Emerging evidence shows that atherosclerotic plaque burden, and not stenosis per se, is the main driver of ASCVD risk in patients with CAD. This information challenges the current paradigm of selecting patients for intensive secondary prevention measures based primarily on the presence of obstructive CAD.

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Conflict of interest statement

Conflicts of interest

There are no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Major atherosclerotic cardiovascular disease event and all-cause mortality event rate across increasing coronary artery calcium burden and stenosis severity. *Myocardial infarction, stroke, and all-cause mortality.
FIGURE 2.
FIGURE 2.
Hazard for myocardial infarction, stroke, and all-cause mortality for persons with and without obstructive coronary artery disease, stratified by coronary artery calcium score.
See this image and copyright information in PMC

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