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Title:

Progression of whole-heart Atherosclerosis by coronary CT and major adverse cardiovascular events.

Document type:
Article; Journal Article
Author(s):
van Rosendael, Alexander R; Lin, Fay Y; van den Hoogen, Inge J; Ma, Xiaoyue; Gianni, Umberto; Al Hussein Alawamlh, Omar; Al'Aref, Subhi J; Peña, Jessica M; Andreini, Daniele; Budoff, Matthew J; Cademartiri, Filippo; Chinnaiyan, Kavitha; Choi, Jung Hyun; Conte, Edoardo; Marques, Hugo; de Araújo Gonçalves, Pedro; Gottlieb, Ilan; Hadamitzky, Martin; Leipsic, Jonathon; Maffei, Erica; Pontone, Gianluca; Raff, Gilbert L; Shin, Sanghoon; Kim, Yong-Jin; Lee, Byoung Kwon; Chun, Eun Ju; Sung, Ji Min; Lee,...     »
Abstract:
BACKGROUND: The current study aimed to examine the independent prognostic value of whole-heart atherosclerosis progression by serial coronary computed tomography angiography (CCTA) for major adverse cardiovascular events (MACE). METHODS: The multi-center PARADIGM study includes patients undergoing serial CCTA for symptomatic reasons, ≥2 years apart. Whole-heart atherosclerosis was characterized on a segmental level, with co-registration of baseline and follow-up CCTA, and summed to per-patient level. The independent prognostic significance of atherosclerosis progression for MACE (non-fatal myocardial infarction [MI], death, unplanned coronary revascularization) was examined. Patients experiencing interval MACE were not omitted. RESULTS: The study population comprised 1166 patients (age 60.5 ​± ​9.5 years, 54.7% male) who experienced 139 MACE events during 8.2 (IQR 6.2, 9.5) years of follow up (15 death, 5 non-fatal MI, 119 unplanned revascularizations). Whole-heart percent atheroma volume (PAV) increased from 2.32% at baseline to 4.04% at follow-up. Adjusted for baseline PAV, the annualized increase in PAV was independently associated with MACE: OR 1.23 (95% CI 1.08, 1.39) per 1 standard deviation increase, which was consistent in multiple subpopulations. When categorized by composition, only non-calcified plaque progression associated independently with MACE, while calcified plaque did not. Restricting to patients without events before follow-up CCTA, those with future MACE showed an annualized increase in PAV of 0.93% (IQR 0.34, 1.96) vs 0.32% (IQR 0.02, 0.90), P ​< ​0.001. CONCLUSIONS: Whole-heart atherosclerosis progression examined by serial CCTA is independently associated with MACE, with a prognostic threshold of 1.0% increase in PAV per year.
Journal title abbreviation:
J Cardiovasc Comput Tomogr
Year:
2021
Journal volume:
15
Journal issue:
4
Pages contribution:
322-330
Fulltext / DOI:
doi:10.1016/j.jcct.2020.12.007
Pubmed ID:
http://view.ncbi.nlm.nih.gov/pubmed/33451974
Print-ISSN:
1934-5925
TUM Institution:
Institut für Radiologie und Nuklearmedizin
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