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- Title
Association of coronary artery calcium score with qualitatively and quantitatively assessed adverse plaque on coronary CT angiography in the SCOT-HEART trial.
- Authors
Osborne-Grinter, Maia; Kwiecinski, Jacek; Doris, Mhairi; McElhinney, Priscilla; Cadet, Sebastien; Adamson, Philip D; Moss, Alastair J; Alam, Shirjel; Hunter, Amanda; Shah, Anoop S V; Mills, Nicholas L; Pawade, Tania; Wang, Chengjia; Weir-McCall, Jonathan R; Roditi, Giles; Beek, Edwin J R van; Shaw, Leslee J; Nicol, Edward D; Berman, Daniel; Slomka, Piotr J
- Abstract
Aims Coronary artery calcification is a marker of cardiovascular risk, but its association with qualitatively and quantitatively assessed plaque subtypes is unknown. Methods and results In this post-hoc analysis, computed tomography (CT) images and 5-year clinical outcomes were assessed in SCOT-HEART trial participants. Agatston coronary artery calcium score (CACS) was measured on non-contrast CT and was stratified as zero (0 Agatston units, AU), minimal (1–9 AU), low (10–99 AU), moderate (100–399 AU), high (400–999 AU), and very high (≥1000 AU). Adverse plaques were investigated by qualitative (visual categorization of positive remodelling, low-attenuation plaque, spotty calcification, and napkin ring sign) and quantitative (calcified, non-calcified, low-attenuation, and total plaque burden; Autoplaque) assessments. Of 1769 patients, 36% had a zero, 9% minimal, 20% low, 17% moderate, 10% high, and 8% very high CACS. Amongst patients with a zero CACS, 14% had non-obstructive disease, 2% had obstructive disease, 2% had visually assessed adverse plaques, and 13% had low-attenuation plaque burden >4%. Non-calcified and low-attenuation plaque burden increased between patients with zero, minimal, and low CACS (P < 0.001), but there was no statistically significant difference between those with medium, high, and very high CACS. Myocardial infarction occurred in 41 patients, 10% of whom had zero CACS. CACS >1000 AU and low-attenuation plaque burden were the only predictors of myocardial infarction, independent of obstructive disease, and 10-year cardiovascular risk score. Conclusion In patients with stable chest pain, zero CACS is associated with a good but not perfect prognosis, and CACS cannot rule out obstructive coronary artery disease, non-obstructive plaque, or adverse plaque phenotypes, including low-attenuation plaque.
- Subjects
CARDIOVASCULAR diseases risk factors; STATISTICS; CORONARY angiography; DESCRIPTIVE statistics; CHEST pain; CORONARY artery calcification; DATA analysis; PHENOTYPES
- Publication
European Heart Journal - Cardiovascular Imaging, 2022, Vol 23, Issue 9, p1210
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jeab135