January 25, 2019
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Adverse plaque characteristics, burden increase risk for death, MI

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Photo of Leslee Shaw
Leslee J. Shaw

Patients with overall calcified plaque burden and adverse coronary plaque characteristics had an increased risk for death related to CHD or nonfatal MI, according to a secondary post hoc analysis of the SCOT-HEART study published in the Journal of the American College of Cardiology.

Michelle C. Williams, MBChB, PhD, clinical lecturer in cardiothoracic radiology and special trainee in radiology at the University of Edinburgh in the United Kingdom, and colleagues analyzed data from 1,769 patients (mean age, 58 years; 56% men) from the SCOT-HEART study who underwent coronary CTA. Noncontrast CT was used to develop a coronary artery calcium score.

The primary clinical endpoint was the occurrence of nonfatal MI or death related to CHD.

During a median of 4.7 years of follow-up, 34% of patients had one or more adverse plaque features.

Patients with adverse plaque were three times more likely to have a nonfatal MI or die of CHD-related causes compared with those without plaque (4.1% vs. 1.4%; HR = 3.01; 95% CI, 1.61-5.63). Patients with obstructive CAD were also twice as likely to have a nonfatal MI or death from CHD (HR = 1.99; 95% CI, 1.05-3.79).

The highest event rate was seen in patients with obstructive disease and adverse plaque compared with those with normal coronary arteries (HR = 11.5; 95% CI, 3.39-39.04). The presence of obstructive plaque and adverse plaque was dependent on the CAC score to predict an increased risk for nonfatal MI or death from CHD.

“This may aid the identification of a subgroup of patients who would benefit from more intensive medical therapy,” Williams and colleagues wrote.

“Given the ability to perform whole-heart atherosclerosis quantification and characterization by noninvasive imaging, we are now able to perform analysis on large clinical populations and likely are on the precipice of a greater understanding of CAD risk based on diverse atherosclerotic-disease markers,” Cardiology Today Editorial Board Member Leslee J. Shaw, PhD, outcome research scientist and professor of medicine and radiology at Weill Cornell Medical College in New York, and colleagues wrote in a related editorial. “It is also important that we pay attention to the dynamicity rather than cross-sectional characteristic of the plaques. With this ability, it appears that each unfolding analysis may further reveal how complicated the disease process is and how limited our knowledge is of risk associated with atherosclerotic plaque.” – by Darlene Dobkowski

Disclosures: Williams report she received support by the British Heart Foundation and The Chief Scientist Office of the Scottish Government Health and has served as a consultant for GE Healthcare. Shaw reports no relevant financial disclosures. Please see the study and editorial for all other authors’ relevant financial disclosures.