Quantified coronary total plaque volume from computed tomography angiography provides superior 10-year risk stratification
European Heart Journal - Cardiovascular Imaging, vol. 22, pp. 314–321
Abstract
AIMS: Automated coronary total plaque volume (TPV) quantification derived from coronary computed tomographic angiography (CTA) datasets provide exact and reliable assessment of calcified and non-calcified coronary atherosclerosis burden. The aim of this analysis was to investigate the long-term predictive value of TPV. METHODS AND RESULTS: TPV was quantified in 1577 patients undergoing coronary CTA and cardiovascular events were collected during 10.5 years (interquartile range 6.0-11.4) of follow-up. The study endpoint comprised cardiac death and acute coronary syndrome and occurred in 59 (3.7%) patients. Coronary TPV provided additive prognostic value over clinical risk assessed with the Morise Score and coronary artery disease severity (rise in C-index from 0.744 to 0.769, P = 0.03). A category-based reclassification approach combining the Morise Score and TPV revealed superior risk stratification (categorical net reclassification improvement: 0.48 with 95% CI 0.13-0.68, P < 0.001) and resulted in reclassification of 800 (51%) patients compared with the Morise Score alone. The 10-year risk for the study endpoint was 0.6% (95% CI 0-1.3) for patients classified as low risk (n = 807), 4.8% (95% CI 2.4-7.2) for patients at intermediate risk (n = 400), and 10.3% (95% CI 6.6-13.9) for patients at high risk (n = 370) using the combined reclassification approach. CONCLUSION: Quantification of TPV from coronary CTA permits an improved 10-year cardiovascular risk stratification.
Authors 10
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Simon Deseive corresponding
LMU Klinikum · German Centre for Cardiovascular Research · Ludwig-Maximilians-Universität München
Affiliation as printed
Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 Munich, Germany
Munich Heart Alliance at DZHK, Munich, Germany
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LMU Klinikum · Ludwig-Maximilians-Universität München
Affiliation as printed
Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 Munich, Germany
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LMU Klinikum · Ludwig-Maximilians-Universität München
Affiliation as printed
Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 Munich, Germany
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LMU Klinikum · German Centre for Cardiovascular Research · Ludwig-Maximilians-Universität München
Affiliation as printed
Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 Munich, Germany
Munich Heart Alliance at DZHK, Munich, Germany
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Alexander Broersen Aachen Division of Image Processing Department of Radiology, Leiden University Medical Center
Leiden University · Leiden University Medical Center
Affiliation as printed
Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Pieter H. Kitslaar Aachen Division of Image Processing Department of Radiology, Leiden University Medical Center
Leiden University · Leiden University Medical Center
Affiliation as printed
Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
Medis Medical Imaging Systems BV, Leiden, The Netherlands
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Affiliation as printed
Division of Radiology, Deutsches Herzzentrum München, Munich, Germany
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LMU Klinikum · German Centre for Cardiovascular Research · Ludwig-Maximilians-Universität München
Affiliation as printed
Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 Munich, Germany
Munich Heart Alliance at DZHK, Munich, Germany
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Affiliation as printed
Division of Radiology, Deutsches Herzzentrum München, Munich, Germany
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LMU Klinikum · German Centre for Cardiovascular Research · Ludwig-Maximilians-Universität München
Affiliation as printed
Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 Munich, Germany
Munich Heart Alliance at DZHK, Munich, Germany
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