Author + information
- Received February 25, 2015
- Revision received May 5, 2015
- Accepted May 13, 2015
- Published online July 28, 2015.
- Sadako Motoyama, MD, PhD∗,†∗ (, )
- Hajime Ito, MD, PhD∗,
- Masayoshi Sarai, MD, PhD∗,
- Takeshi Kondo, MD, PhD∗,
- Hideki Kawai, MD, PhD∗,
- Yasuomi Nagahara, MD∗,
- Hiroto Harigaya, MD, PhD∗,‡,
- Shino Kan, MD∗,‡,
- Hirofumi Anno, MD, PhD§,
- Hiroshi Takahashi, BSc‖,
- Hiroyuki Naruse, MD, PhD∗,
- Junichi Ishii, MD, PhD∗,
- Harvey Hecht, MD†,
- Leslee J. Shaw, PhD¶,
- Yukio Ozaki, MD, PhD∗ and
- Jagat Narula, MD, PhD†∗∗ ()
- ∗Department of Cardiology, Fujita Health University, Toyoake, Japan
- †Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York
- ‡Department of Cardiology, Nagoya Memorial Hospital, Nagoya, Japan
- §Department of Radiology, Fujita Health University, Toyoake, Japan
- ‖Division of Medical Statistics, Fujita Health University, Toyoake, Japan
- ¶Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- ↵∗Reprint requests and correspondence:
Dr. Sadako Motoyama, Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Katsukake, Toyoake, Aichi 470-1192, Japan.
- ↵∗∗Dr. Jagat Narula, Division of Cardiology, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
Background Coronary computed tomography angiography (CTA)-verified positive remodeling and low attenuation plaques are considered morphological characteristics of high-risk plaque (HRP) and predict short-term risk of acute coronary syndrome (ACS).
Objectives This study evaluated whether plaque characteristics by CTA predict mid-term likelihood of ACS.
Methods The presence of HRP and significant stenosis (SS) of ≥70% were evaluated in 3,158 patients undergoing CTA. Serial CTA was performed in 449 patients, and plaque progression (PP) was evaluated. Outcomes (fatal and nonfatal ACS) were recorded during follow-up (mean 3.9 ± 2.4 years).
Results ACS occurred in 88 (2.8%) patients: 48 (16.3%) of 294 HRP(+) and 40 (1.4%) of 2,864 HRP(−) patients. ACS was also significantly more frequent in SS(+) (36 of 659; 5.5%) than SS(−) patients (52 of 2,499; 2.1%). HRP(+)/SS(+) (19%) and HRP(+)/SS(−) (15%) had higher rates of ACS compared with no-plaque patients (0.6%). Although ACS incidence was relatively low in HRP(−) patients, the cumulative number of patients with ACS developing from HRP(−) lesions (n = 43) was similar to ACS patients with HRP(+) lesions (n = 45). In patients with serial CTA, PP also was an independent predictor of ACS, with HRP (27%; p < 0.0001) and without HRP (10%) compared with HRP(−)/PP(−) patients (0.3%).
Conclusions CTA-verified HRP was an independent predictor of ACS. However, the cumulative number of ACS patients with HRP(−) was similar to patients with HRP(+). Additionally, plaque progression detected by serial CTA was an independent predictor of ACS.
Dr. Hecht is a consultant to Philips Medical Systems and HeartFlow Inc.; and has served on the Scientific Advisory Board of Arineta Ltd. Dr. Narula has received research support from Philips and GE Healthcare in the form of an equipment grant to the institution, unrelated to the current project. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Motoyama and Ito contributed equally to this work. Daniel Berman, MD, served as Guest Editor for this paper.
- Received February 25, 2015.
- Revision received May 5, 2015.
- Accepted May 13, 2015.
- American College of Cardiology Foundation