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European Radiology

, Volume 28, Issue 3, pp 1066–1076 | Cite as

Prognostic value of coronary atherosclerosis progression evaluated by coronary CT angiography in patients with stable angina

  • Hui Gu
  • Yang Gao
  • Zhihui Hou
  • U. Joseph Schoepf
  • Alan N. Snyder
  • Taylor M. Duguay
  • Ximing WangEmail author
  • Bin LuEmail author
Computed Tomography

Abstract

Objectives

To investigate the progression of coronary atherosclerosis burden by coronary CT angiography (CCTA) and to demonstrate its association with the incidence of major adverse cardiac events (MACE).

Methods

We retrospectively studied patients with stable angina who had undergone repeat CCTA due to recurrent or worsening symptoms. Lipid-rich, fibrous, calcified and total plaque burden as well as coronary diameter stenosis were quantitatively analysed. The incidence of MACE during follow-up was determined.

Results

The final cohort consisted of 268 patients (mean age 52.9 ± 9.8 years, 71 % male) with a mean follow-up period of 4.6 ± 0.9 years. Patients with lipid-rich, fibrous, calcified and total plaque burden (%) progression, as well as coronary diameter stenosis (%) progression had a significantly higher incidence of MACE than those without (all p < 0.05). The progression of lipid-rich plaque (HR = 1.601, p = 0.021), total plaque burden (HR = 2.979, p = 0.043) and coronary diameter stenosis (HR = 4.327, p <0.001) were independent predictors of MACE (all p < 0.05).

Conclusions

Patients presenting with recurrent or worsening symptoms associated with coronary artery disease who have coronary atherosclerosis progression on CCTA are at an increased risk of future MACE.

Key Points

• Repeat CCTA can provide information regarding the progression of coronary atherosclerosis.

• Coronary atherosclerosis progression at CCTA is independently associated with MACE.

• CCTA findings could serve as incremental predictors of MACE.

Keywords

Coronary artery disease Coronary atherosclerosis Progression Major adverse cardiac events Repeat coronary CT angiography 

Abbreviations

CABG

Coronary artery bypass grafting

CAC

Coronary artery calcium

CAD

Coronary artery disease

CCTA

Coronary CT angiography

CI

Confidence interval

HR

Hazard ratio

IVUS

Intravascular ultrasound

ICC

Intra-class correlation coefficients

MACE

Major adverse cardiac events

OR

Odds ratio

PCI

Percutaneous coronary intervention

Notes

Compliance with ethical standards

Guarantor

The scientific guarantors of this publication are Bin Lu and Ximing Wang.

Conflict of interest

Dr. Schoepf receives institutional research support from Astellas, Bayer, GE, and Siemens and received consulting fees from Bayer, Guerbet, and Siemens.

Funding

This work had been supported by the key special Grant of Chinese Government (2016YFC1300400 and 2007BAI05B02), and National Natural Science Foundation of China (81371548, 81571672 and 81171343) and a Taishan Scholar Projection.

Statistics and biometry

Dr Richard Takx from Utrecht University was the expert in statistics or biometry in the preparation of this manuscript.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Methodology

• retrospective

• cross-sectional study

• performed at one institution

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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Hui Gu
    • 1
    • 2
  • Yang Gao
    • 2
  • Zhihui Hou
    • 2
  • U. Joseph Schoepf
    • 3
  • Alan N. Snyder
    • 3
  • Taylor M. Duguay
    • 3
  • Ximing Wang
    • 1
    Email author
  • Bin Lu
    • 2
    Email author
  1. 1.Department of CT, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research InstituteShandong UniversityJinanChina
  2. 2.Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  3. 3.Division of Cardiovascular Imaging, Department of Radiology and Radiological ScienceMedical University of South CarolinaCharlestonUSA

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