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



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).


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.


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).


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.


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



Coronary artery bypass grafting


Coronary artery calcium


Coronary artery disease


Coronary CT angiography


Confidence interval


Hazard ratio


Intravascular ultrasound


Intra-class correlation coefficients


Major adverse cardiac events


Odds ratio


Percutaneous coronary intervention


Compliance with ethical standards


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.


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.


• 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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