Author + information
- Nitesh Nerlekar,
- Caitlin Cheshire,
- Hashrul Rashid,
- Rahul Muthalaly,
- James Cameron,
- Ian Meredith,
- Sujith Seneviratne,
- Dennis Wong and
- Adam Brown
Background: Previous studies using intracoronary imaging have found associations between coronary plaque morphology and major adverse cardiovascular events (MACE), but were limited in clinical translation due to their invasive nature. Computed tomography coronary angiography (CTCA) is an alternative, non-invasive imaging modality that also allows plaque characterization. We therefore performed a meta-analysis assessing the association between plaque characteristics and long-term outcome in patients with stable symptoms undergoing CTCA.
Methods: Pubmed, Medline and Embase were systematically searched until October 2016. Outcomes were regarded as trial-specific definitions of MACE, with plaque on CTCA classified as calcified, non-calcified (NCP) or mixed. High risk plaque (HRP) included spotty calcification (SC), low-attenuation plaque (LAP), positive remodelling (PR) and napkin-ring sign (NRS). Random effects modelling was used and results are reported as pooled hazard ratio (HR) with 95% confidence intervals (95% Cl). Heterogeneity was measured with I2 statistic.
Results: Nineteen studies with 19,943 subjects were identified, with 7 studies (n=7,348) evaluating specific HRP features. Mean follow-up ranged from 1.5-8 years with 1,048 total MACE. The pooled HR for the presence of plaque-type on MACE was 1.27 (95% CI 1.17-1.38, p<0.001) I2=86%. Mixed plaque demonstrated the highest risk plaque-type, HR 1.42 (95% CI 1.16-1.68, p<0.001) followed by NCP 1.29 (95% CI 1.10-1.48, p<0.001) and calcified plaque 1.18 (95% CI 1.06-1.31, p<0.001), all I2>75%. Individual HRP components demonstrated higher MACE risk: LAP 3.21 (95% CI 2.02-5.10, p<0.001) I2=26%; PR 3.22 (95% CI 1.74-5.94, p<0.001) I2=69%; SC 2.26 (95% CI 1.26-4.04, p=0.006) I2=0%; NRS 5.06 (95% CI 3.23-7.94, p<0.001), I2=0%. The presence of any HRP had the highest risk of MACE, HR 7.72 (95% CI 5.44-10.96, p<0.001), I2=0%.
Conclusions: CTCA derived plaque morphology is associated with future prognosis, with the strongest association seen with HRP features.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Non Invasive Imaging: Prognostic Implications of CT Angiography
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1247-229
- 2017 American College of Cardiology Foundation