TY - JOUR
T1 - Non-obstructive high-risk plaques increase the risk of future culprit lesions comparable to obstructive plaques without high-risk features
T2 - The iconic study
AU - Ferraro, Richard A.
AU - van Rosendael, Alexander R.
AU - Lu, Yao
AU - Andreini, Daniele
AU - Al-Mallah, Mouaz H.
AU - Cademartiri, Filippo
AU - Chinnaiyan, Kavitha
AU - Chow, Benjamin J.W.
AU - Conte, Edoardo
AU - Cury, Ricardo C.
AU - Feuchtner, Gudrun
AU - de Araújo Gonçalves, Pedro
AU - Hadamitzky, Martin
AU - Kim, Yong Jin
AU - Leipsic, Jonathon
AU - Maffei, Erica
AU - Marques, Hugo
AU - Plank, Fabian
AU - Pontone, Gianluca
AU - Raff, Gilbert L.
AU - Villines, Todd C.
AU - Lee, Sang Eun
AU - Al'Aref, Subhi J.
AU - Baskaran, Lohendran
AU - Cho, Iksung
AU - Danad, Ibrahim
AU - Gransar, Heidi
AU - Budoff, Matthew J.
AU - Samady, Habib
AU - Stone, Peter H.
AU - Virmani, Renu
AU - Narula, Jagat
AU - Berman, Daniel S.
AU - Chang, Hyuk Jae
AU - Bax, Jeroen J.
AU - Min, James K.
AU - Shaw, Leslee J.
AU - Lin, Fay Y.
N1 - Funding Information:
This work was supported by the NIH (HL115150) and the Leading Foreign Research Institute Recruitment Program of the National Research Foundation of Korea, Ministry of Science, ICT & Future Planning (Seoul, Korea).
Publisher Copyright:
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: [email protected].
PY - 2020/9/1
Y1 - 2020/9/1
N2 - AIMS: High-risk plaque (HRP) and non-obstructive coronary artery disease independently predict adverse events, but their importance to future culprit lesions has not been resolved. We sought to determine in patients prior to confirmed acute coronary syndrome (ACS) the association between lesion percent diameter stenosis (%DS), and the absolute number and prevalence of HRP. The secondary objective was to examine the relative importance of non-obstructive HRP in future culprit lesions.METHODS AND RESULTS: Within the ICONIC study, a nested case-control study of patients undergoing coronary computed tomographic angiography (coronary CT), we included ACS cases with culprit lesions confirmed by invasive coronary angiography and coregistered to baseline coronary CT. Quantitative CT was used to evaluate obstructive (≥50%) and non-obstructive (<50%) diameter stenosis, with HRP defined as ≥2 features of spotty calcification, positive remodelling, or low-attenuation plaque at baseline. A total of 234 patients with downstream ACS over 54 (interquartile range 5-525.5) days exhibited 198/898 plaques with HRP on coronary CT. While HRP was less prevalent in non-obstructive (19.7%, 161/819) than obstructive lesions (46.8%, 37/79, P < 0.001), non-obstructive plaque comprised 81.3% (161/198) of HRP lesions overall. Among the 128 patients with identifiable culprit lesion precursors, the adjusted hazard ratio (HR) was 1.85 [95% confidence interval (CI) 1.26-2.72] for HRP, with no interaction between %DS and HRP (P = 0.82). Compared to non-obstructive HRP lesions, obstructive lesions without HRP exhibited a non-significant HR of 1.41 (95% CI 0.61-3.25, P = 0.42).CONCLUSIONS: While HRP is more prevalent among obstructive lesions, non-obstructive HRP lesions outnumber those that are obstructive and confer risk clinically approaching that of obstructive lesions without HRP.
AB - AIMS: High-risk plaque (HRP) and non-obstructive coronary artery disease independently predict adverse events, but their importance to future culprit lesions has not been resolved. We sought to determine in patients prior to confirmed acute coronary syndrome (ACS) the association between lesion percent diameter stenosis (%DS), and the absolute number and prevalence of HRP. The secondary objective was to examine the relative importance of non-obstructive HRP in future culprit lesions.METHODS AND RESULTS: Within the ICONIC study, a nested case-control study of patients undergoing coronary computed tomographic angiography (coronary CT), we included ACS cases with culprit lesions confirmed by invasive coronary angiography and coregistered to baseline coronary CT. Quantitative CT was used to evaluate obstructive (≥50%) and non-obstructive (<50%) diameter stenosis, with HRP defined as ≥2 features of spotty calcification, positive remodelling, or low-attenuation plaque at baseline. A total of 234 patients with downstream ACS over 54 (interquartile range 5-525.5) days exhibited 198/898 plaques with HRP on coronary CT. While HRP was less prevalent in non-obstructive (19.7%, 161/819) than obstructive lesions (46.8%, 37/79, P < 0.001), non-obstructive plaque comprised 81.3% (161/198) of HRP lesions overall. Among the 128 patients with identifiable culprit lesion precursors, the adjusted hazard ratio (HR) was 1.85 [95% confidence interval (CI) 1.26-2.72] for HRP, with no interaction between %DS and HRP (P = 0.82). Compared to non-obstructive HRP lesions, obstructive lesions without HRP exhibited a non-significant HR of 1.41 (95% CI 0.61-3.25, P = 0.42).CONCLUSIONS: While HRP is more prevalent among obstructive lesions, non-obstructive HRP lesions outnumber those that are obstructive and confer risk clinically approaching that of obstructive lesions without HRP.
KW - Coronary artery disease
KW - Coronary computed tomographic angiography
KW - Myocardial infarction
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U2 - 10.1093/ehjci/jeaa048
DO - 10.1093/ehjci/jeaa048
M3 - Article
C2 - 32535636
AN - SCOPUS:85089787072
SN - 2047-2404
VL - 21
SP - 973
EP - 980
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 9
ER -