Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2026 Feb 27;27(3):554-566.
doi: 10.1093/ehjci/jeaf372.

Outcomes with revascularization vs. medical therapy according to plaque burden from coronary computed tomography angiography

Sarah Bär  1   2 , Juhani Knuuti  1   3 , Antti Saraste  1   4 , Nick S Nurmohamed  5 , Ruurt A Jukema  5   6 , Riku Klén  1 , Jeroen J Bax  7 , Paul Knaapen  5 , Ibrahim Danad  8 , Teemu Maaniitty  1   3
Affiliations

Outcomes with revascularization vs. medical therapy according to plaque burden from coronary computed tomography angiography

Sarah Bär et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: We aimed to investigate whether plaque burden from coronary computed tomography angiography (CCTA) could be used to identify patients potentially benefitting from revascularization.

Methods and results: We assessed consecutive patients undergoing CCTA and selective 15O-water perfusion positron emission tomography for evaluation of coronary artery disease (CAD) at two tertiary care centres in Finland and The Netherlands. Per-patient percent atheroma volume (PAV) and maximum per-vessel PAV in each patient was quantified by artificial intelligence-guided quantitative computed tomography (AI-QCT). We constructed a Cox regression for death, myocardial infarction (MI), or unstable angina pectoris (uAP) including continuous PAV, revascularization, and their interaction, adjusted for calcium score, ischaemia, cardiovascular risk factors, symptoms, and medication in a subcohort of 2233 patients (206 events; median follow-up 6.8 years). There was significant interaction between revascularization and continuous PAV on patient-level (p-interaction = 0.042) and vessel-level (p-interaction = 0.026). Revascularization was associated with a significantly lower event rate at per-patient PAV 22% (HR 0.70, 95% CI 0.43-0.98) and per-vessel PAV 22% (HR 0.64, 95% CI 0.29-0.99) or higher. In subgroup analyses, after adjustment for age, sex, cardiovascular risk factors, ischaemia, anti-platelet, and lipid-lowering drugs, revascularization in patients with per-vessel PAV ≥22% was associated with a significantly reduced event rate (HR 0.50, 95% CI 0.27-0.91, P = 0.024) (p-interaction = 0.016), whereas patient-level results remained non-significant (HR 0.62, 95% CI 0.35-1.10, P = 0.104) (p-interaction < 0.001).

Conclusions: In this cohort study of patients referred for CCTA, revascularization on top of medical therapy was associated with a lower rate of long-term death, MI, or uAP from per-vessel PAV of 22% upwards.

Keywords: artificial intelligence; coronary computed tomography angiography; plaque burden; revascularization.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: S.B. received research grants to the institution from Medis Medical Imaging Systems and Abbott, outside the submitted work, speaker fees from Cleerly, Inc., and travel fees from Sanofi. J.K. received consultancy fees from GE Healthcare and Synektik and speaker fees from Bayer, Lundbeck, Boehringer-Ingelheim, Pfizer, and Siemens, outside of the submitted work. A.S. received consultancy fees from AstraZeneca and Pfizer, and speaker fees from Abbott, AstraZeneca, Janssen, Novartis, and Pfizer. J.J.B. received speaker fees from Abbott. N.S.N. reports grants from the Dutch Heart Foundation (Dekker 03-007-2023-0068), European Atherosclerosis Society (2023), research funding/speaker fees from Cleerly, Daiichi Sankyo, and Novartis, and is co-founder of Lipid Tools. I.D. is a member of the Cleerly Scientific Advisory Board and an Associate Editor at the European Heart Journal Cardiovascular Imaging. P.K. has received research grants from Cleerly, Inc. and HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

LinkOut - more resources