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Meta-Analysis
. 2025 Jul-Aug;19(4):423-432.
doi: 10.1016/j.jcct.2025.05.003. Epub 2025 May 26.

Plaque quantification from coronary computed tomography angiography in predicting cardiovascular events: A systematic review and meta-analysis

Jack S Bell  1 , Jonathan Weir-McCall  2 , Edward Nicol  2 , Gregory Y H Lip  3 , Bjarne L Nørgaard  4 , Timothy A Fairbairn  5
Affiliations
Meta-Analysis

Plaque quantification from coronary computed tomography angiography in predicting cardiovascular events: A systematic review and meta-analysis

Jack S Bell et al. J Cardiovasc Comput Tomogr. 2025 Jul-Aug.

Abstract

Background: Plaque volumes quantified from coronary computed tomography angiography (CCTA) may offer improved risk prediction for future major adverse cardiovascular events (MACE) above current standards of care. This systematic review and meta-analysis examines the association between CCTA-derived plaque volumes and future MACE in stable coronary artery disease (CAD).

Methods: A systematic literature search was undertaken using PubMed, Web of Science and Cochrane Library databases. 504 publications were screened, identifying 38 studies for inclusion in the systematic review. 15 studies were eligible for meta-analysis. Separate meta-analyses were conducted for the most frequently investigated plaque volume variables.

Results: 35 out of 38 included studies showed an association between quantified plaque volumes and MACE. Low attenuation plaque (LAP) volume and total plaque volume (TPV) were most frequently independently associated with MACE. On meta-analysis, there was a significant association between MACE and TPV (pooled HR 3.93, 95 ​% CI 2.10-7.34, p ​< ​0.0001), LAP volume (pooled HR 2.81, 95 ​% CI 2.01-3.93, p ​< ​0.0001), calcified plaque volume (pooled HR 2.21, 95 ​% 1.5-3.24, p ​< ​0.0001), non-calcified plaque volume (pooled HR 2.55, 95 ​% CI 1.30-4.98, p ​= ​0.006), LAP burden (pooled HR 3.22, 95 ​% CI 2.12-4.87, p ​< ​0.0001), calcified plaque burden (pooled HR 2.25, 95 ​% 1.56-3.24, p ​< ​0.0001) and non-calcified plaque burden (pooled HR 3.42, 95 ​% CI 1.49-7.81, p ​= ​0.004). Total plaque burden was significantly associated with MACE after exclusion of a small study driving considerable heterogeneity (pooled HR 3.81, 95 ​% CI 2.45-5.94, p ​< ​0.0001).

Conclusion: Quantified plaque volumes are associated with MACE in patients undergoing CCTA for stable CAD. Future work is required in diverse populations with standardised methods to determine the clinical utility of plaque quantification in real world practice.

Keywords: Coronary computed tomography angiography; Low attenuation plaque; Major adverse cardiac events; Myocardial infarction; Percentage atheroma volume; Plaque burden; Plaque volume; Prognosis; Stable coronary artery disease.

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Conflict of interest statement

Declaration of competing interest G.Y.H.L. Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo. E.D.N. Consultant for Caristo Diagnostics and medneo. B.L.N. Received unrestricted research grants from the Novo Nordisk Foundation, Denmark. No fees are received personally.

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