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Document type:
Journal Article; Multicenter Study; Observational Study 
Author(s):
Lee, Sang-Eun; Sung, Ji Min; Andreini, Daniele; Al-Mallah, Mouaz H; Budoff, Matthew J; Cademartiri, Filippo; Chinnaiyan, Kavitha; Choi, Jung Hyun; Chun, Eun Ju; Conte, Edoardo; Gottlieb, Ilan; Hadamitzky, Martin; Kim, Yong Jin; Lee, Byoung Kwon; Leipsic, Jonathon A; Maffei, Erica; Marques, Hugo; de Araújo Gonçalves, Pedro; Pontone, Gianluca; Shin, Sanghoon; Stone, Peter H; Samady, Habib; Virmani, Renu; Narula, Jagat; Berman, Daniel S; Shaw, Leslee J; Bax, Jeroen J; Lin, Fay Y; Min, James K; Chan...    »
 
Title:
Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study. 
Abstract:
To determine whether the assessment of individual plaques is superior in predicting the progression to obstructive coronary artery disease (CAD) on serial coronary computed tomography angiography (CCTA) than per-patient assessment. From a multinational registry of 2252 patients who underwent serial CCTA at a ≥ 2-year inter-scan interval, patients with only non-obstructive lesions at baseline were enrolled. CCTA was quantitatively analyzed at both the per-patient and per-lesion level. Models predicting the development of an obstructive lesion at follow up using either the per-patient or per-lesion level CCTA measures were constructed and compared. From 1297 patients (mean age 60 ± 9 years, 43% men) enrolled, a total of 3218 non-obstructive lesions were identified at baseline. At follow-up (inter-scan interval: 3.8 ± 1.6 years), 76 lesions (2.4%, 60 patients) became obstructive, defined as > 50% diameter stenosis. The C-statistics of Model 1, adjusted only by clinical risk factors, was 0.684. The addition of per-patient level total plaque volume (PV) and the presence of high-risk plaque (HRP) features to Model 1 improved the C-statistics to 0.825 [95% confidence interval (CI) 0.823-0.827]. When per-lesion level PV and the presence of HRP were added to Model 1, the predictive value of the model improved the C-statistics to 0.895 [95% CI 0.893-0.897]. The model utilizing per-lesion level CCTA measures was superior to the model utilizing per-patient level CCTA measures in predicting the development of an obstructive lesion (p < 0.001). Lesion-level analysis of coronary atherosclerotic plaques with CCTA yielded better predictive power for the development of obstructive CAD than the simple quantification of total coronary atherosclerotic burden at a per-patient level.Clinical Trial Registration: ClinicalTrials.gov NCT0280341. 
Journal title abbreviation:
Int J Cardiovasc Imaging 
Year:
2020 
Journal volume:
36 
Journal issue:
12 
Pages contribution:
2357-2364 
Print-ISSN:
1569-5794 
TUM Institution:
Institut für Radiologie und Nuklearmedizin