Abstract 4144554: Revascularization of Patients with Low-Density Non-Calcified Plaque was Associated with Lower Occurrence of Acute Coronary Syndrome

INTRODUCTION: Coronary CT angiography (CCTA) is a powerful noninvasive tool for identifying high-risk plaque, such as low-density non-calcified plaque (LD-NCP). Though, the optimal treatment of patients with LD-NCP remains unclear. This study explored the association of revascularization in the setting of LD-NCP with the occurrence of acute coronary syndrome (ACS). Methods: This was a post-hoc analysis of the ICONIC study. A subset of 234 patients that underwent CCTA with subsequent ACS were matched to 234 control patients who also underwent CCTA but did not have ACS during follow-up. Patients were also followed for occurrence of revascularization, either coronary artery bypass graft or percutaneous coronary intervention. Atherosclerosis imaging-enabled quantitative CT (AI-QCT) was used to measure diameter stenosis, and LD-NCP, non-calcified plaque, and calcified plaque volumes from each CCTA. LD-NCP was defined as plaque with -190 to 30 Hounsfield Units. Patients were stratified based on the presence of LD-NCP. Subgroup analysis was conducted to compare the occurrence of ACS with the rate of revascularization. Kaplan-Meier survival curves and extended Cox regression analysis were used to evaluate the effect size of revascularization and LD-NCP on occurrence of ACS. Results: AI-QCT was completed in 448/468 subjects (follow-up time [MEAN±SD] 2.44±2.48 years). The median of LD-NCP was 1.2 mm 3 for patients with >0 mm 3 LD-NCP. There were 85 patients with LD-NCP >1.2 mm 3 and 363 patients with LD-NCP ≤1.2 mm 3 . In patients with LD-NCP >1.2 mm 3 , the rate of revascularization in patients with and without ACS was 3/52 (5.8%) versus 14/33 (42.4%) (p<0.001). In patients with LD-NCP ≤1.2 mm 3 , the rate of revascularization in patients with and without ACS was 36/170 (21.2%) versus 39/193 (20.2%) (p=0.897). In comparison to patients without revascularization and LD-NCP ≤1.2 mm 3 , patients with LD-NCP >1.2 mm 3 and revascularization were less likely to have ACS during follow-up (adjusted HR: 0.20 [0.07, 0.61]; p=0.005). Additionally, patients with LD-NCP >1.2 mm 3 who did not undergo revascularization were more likely to have ACS (adjusted HR: 1.47 [1.03, 2.12]; p=0.036). Hazard ratios were adjusted for diameter stenosis, and non-calcified and calcified plaque volume. Time-dependent coefficients were included for diameter stenosis. Conclusion: Revascularization of patients with LD-NCP >1.2 mm 3 identified on CCTA with AI-QCT was associated with less risk for ACS.

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Journal
Circulation
Published
2024-11-11
DOI
https://doi.org/10.1161/circ.150.suppl_1.4144554
Primary Topic
Peripheral Artery Disease Management
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article

Abstract 4144554: Revascularization of Patients with Low-Density Non-Calcified Plaque was Associated with Lower Occurrence of Acute Coronary Syndrome

Daniele Andreini, Jonathon A Leipsic, Todd C. Villines, Kavitha M. Chinnaiyan et al.
Circulation
Peripheral Artery Disease Management
article

Abstract 4144554: Revascularization of Patients with Low-Density Non-Calcified Plaque was Associated with Lower Occurrence of Acute Coronary Syndrome

Daniele Andreini, Jonathon A Leipsic, Todd C. Villines, Kavitha M. Chinnaiyan, Hugo Marques, Wijnand J. Stuijfzand, Habib Samady, Filippo Cademartiri, Iksung Cho, Ran Heo, Alexander van Rosendael, Nick S. Nurmohamed, Jagat Narula, Subhi J. Al’Aref, Benjamin J.W. Chow, Martin Hadamitzky, Ibrahim Danad, Erica Maffei, Ricardo C. Cury, Lohendran Baskaran, Edoardo Conte, Andrew Choi, Hyung‐Bok Park, Renu Virmani, Gianluca Pontone, Asim Rizvi, Peter H. Stone, Matthew Jay Budoff, Hyuk‐Jae Chang, Leslee Shaw, Logan Hubbard, Sabee Molloi, Shant Malkasian, Gudrun Feuchtner, Fabian Plank, Ji Hyun Lee, Yong‐Jin Kim, Sang‐Eun Lee, Yao Lu, Jeroen Bax
article en

Abstract

INTRODUCTION: Coronary CT angiography (CCTA) is a powerful noninvasive tool for identifying high-risk plaque, such as low-density non-calcified plaque (LD-NCP). Though, the optimal treatment of patients with LD-NCP remains unclear. This study explored the association of revascularization in the setting of LD-NCP with the occurrence of acute coronary syndrome (ACS). Methods: This was a post-hoc analysis of the ICONIC study. A subset of 234 patients that underwent CCTA with subsequent ACS were matched to 234 control patients who also underwent CCTA but did not have ACS during follow-up. Patients were also followed for occurrence of revascularization, either coronary artery bypass graft or percutaneous coronary intervention. Atherosclerosis imaging-enabled quantitative CT (AI-QCT) was used to measure diameter stenosis, and LD-NCP, non-calcified plaque, and calcified plaque volumes from each CCTA. LD-NCP was defined as plaque with -190 to 30 Hounsfield Units. Patients were stratified based on the presence of LD-NCP. Subgroup analysis was conducted to compare the occurrence of ACS with the rate of revascularization. Kaplan-Meier survival curves and extended Cox regression analysis were used to evaluate the effect size of revascularization and LD-NCP on occurrence of ACS. Results: AI-QCT was completed in 448/468 subjects (follow-up time [MEAN±SD] 2.44±2.48 years). The median of LD-NCP was 1.2 mm 3 for patients with >0 mm 3 LD-NCP. There were 85 patients with LD-NCP >1.2 mm 3 and 363 patients with LD-NCP ≤1.2 mm 3 . In patients with LD-NCP >1.2 mm 3 , the rate of revascularization in patients with and without ACS was 3/52 (5.8%) versus 14/33 (42.4%) (p<0.001). In patients with LD-NCP ≤1.2 mm 3 , the rate of revascularization in patients with and without ACS was 36/170 (21.2%) versus 39/193 (20.2%) (p=0.897). In comparison to patients without revascularization and LD-NCP ≤1.2 mm 3 , patients with LD-NCP >1.2 mm 3 and revascularization were less likely to have ACS during follow-up (adjusted HR: 0.20 [0.07, 0.61]; p=0.005). Additionally, patients with LD-NCP >1.2 mm 3 who did not undergo revascularization were more likely to have ACS (adjusted HR: 1.47 [1.03, 2.12]; p=0.036). Hazard ratios were adjusted for diameter stenosis, and non-calcified and calcified plaque volume. Time-dependent coefficients were included for diameter stenosis. Conclusion: Revascularization of patients with LD-NCP >1.2 mm 3 identified on CCTA with AI-QCT was associated with less risk for ACS.

CirculationVol. 150(Suppl_1)
Brigham and Women's Hospital (US), University of British Columbia (CA), Innsbruck Medical University (AT), University of Ottawa (CA), Yonsei University (KR), University of California, Irvine (US), University of Arkansas Medical Center (US), Severance Hospital (KR), Seoul National University Hospital (KR), University of California San Diego (US), Centro Cardiologico Monzino (IT), Deutsches Herzzentrum der Charité (DE), Michigan United (US), Hospital da Luz (PT), The Cardiac and Vascular Institute (US), CVPath Institute (US), St. Paul's Hospital (CA), National Heart Centre Singapore (SG), Catholic Kwandong University International St. Mary's Hospital (KR), Amsterdam University Medical Centers (NL), Fondazione Toscana Gabriele Monasterio (IT), GW Medical Faculty Associates (US), The Catholic University of Korea Seoul St. Mary's Hospital (KR), Beaumont Hospital, Troy (US), University of Virginia (US), The University of Texas Medical Branch at Galveston (US), Amsterdam UMC Location Vrije Universiteit Amsterdam (NL), The University of Texas Health Science Center at Houston (US), Icahn School of Medicine at Mount Sinai (US)
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Peripheral Artery Disease Management
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