The Time-Varying Prognostic Value of Stenosis and Plaque Burden in Coronary Artery Disease

Abstract

Aims: Conflicting results have been reported on the prognostic value of coronary stenosis grade and plaque burden. We aimed to investigate the time-varying risk for cardiovascular events associated with diameter stenosis (DS%) and plaque burden.

Methods and results: Patients without a documented cardiac history who underwent coronary computed tomography angiography for suspected coronary artery disease were included. The most severe DS% and plaque burden, defined as percentage atheroma volume (PAV), were used for analysis. The primary end point was a composite of all-cause mortality and non-fatal myocardial infarction. For analysis, the maximal follow-up time was 8 years. Among 2819 patients (mean age 62±10; 1245 (45%) male), 235 events occurred during a median follow-up of 6.9 years. Cox models including cardiovascular risk factors, DS% and PAV demonstrated that DS% but not PAV was predictive for short-term events at 1-year follow-up (adjusted hazard ratio [aHR] 1.028, 95% confidence interval [CI] 1.013-1.044 versus 1.015, 95% CI 0.978-1.053). In contrast, PAV but not DS% was predictive for long-term events at 8-year follow-up (aHR 1.035, 95% CI 1.021-1.050 versus 1.005, 95% CI 0.999-1.012). The predictive value of DS% was stronger before than after 1 year of follow-up (aHR <1 year 1.027, 95% CI 1.012-1.042 vs aHR 1-8 years 1.001, 95% CI 0.994-1.008; p<0.01 for difference), while the predictive value of PAV did not significantly change (p=0.12).

Conclusion: Coronary diameter stenosis holds the highest prognostic significance for short-term cardiovascular events, while plaque burden predicts events in the long term.