Abstract 4370057: Comparison of non-calcified to calcified plaque ratio versus noncalcified plaque burden to predict adverse cardiovascular outcomes in the CONFIRM2 registry

Background: While the burden and morphological features of coronary atherosclerosis are both important drivers of major adverse cardiovascular events (MACE), there remains uncertainty about which plaque type is more likely to predispose to MACE i.e. noncalcified plaque (NCP) or calcified plaque (CP). Research question: Does NCP:CP ratio or NCP volume influence MACE in patients from the CONFIRM2 registry, an international, observational cohort study? Methods: Symptomatic patients without prior MI/revascularization referred to coronary CTA for clinical indications were included. CP and NCP volumes were determined using artificial intelligence-facilitated coronary CT (AI-QCT). The primary endpoint (MACE) was a composite of all-cause death, myocardial infarction, stroke, heart failure, late revascularization, and hospitalization for unstable angina. Results: Of the 3,551 patients (median age 59 years; 49.5% women), data were available for 3,301. A total of 250 patients with no identifiable plaque were excluded from the analysis. MACE occurred in 4.7% of patients (median f/u 51 months). Hypertension, hyperlipidemia, and smoking were present in 54.3%, 48.1%, and 14%. Statin use in 67.3%, CACS = 0 in 41.7%. 91% had NCP <250 mm 3 , 8.4% 250-750 mm 3 and 0.7% >750 mm 3 . MACE rates for tertiles of NCP:CP ratio were statistically significant (Panel A; p=0.0003): 1 st tertile (Mean NCP:CP ratio of 46%; n=1100 patients; median NCP volume = 85.6 mm 3 ; MACE rate of 5.6%); 2 nd tertile (NCP:CP 81%; n=1101; NCPvol. = 67.6 mm 3 ; 6.6%); 3 rd tertile (NCP:CP 99%; n=1100; NCPvol. = 22.3 mm 3 ; 2.9%). However, in a multivariable Cox proportional hazards model adjusted for sex and age, when adjusting also for NCP volume, the NCP:CP tertile ratio did not remain a significant predictor of MACE, p=0.115 (Model#3, Panel B). Only 9 patients had predominant CP (NCP:CP ratio<10%) while the majority had predominant NCP. Conclusions: The main driver of incident MACE was the noncalcified plaque volume (NCP) rather than the NCP:CP ratio. More data with a larger cohort of patients with relatively more CP is needed to evaluate the role of individual features of partially calcified plaques such as spotty calcification to assess if they are better predictors of MACE or whether NCP volume alone is sufficient.

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Journal
Circulation
Published
2025-11-03
DOI
https://doi.org/10.1161/circ.152.suppl_3.4370057
Primary Topic
Cardiac Imaging and Diagnostics
Type
article
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article

Abstract 4370057: Comparison of non-calcified to calcified plaque ratio versus noncalcified plaque burden to predict adverse cardiovascular outcomes in the CONFIRM2 registry

Kelley R. Branch, George Wesbey, Filippo Cademartiri, Mouaz Husayn Al-Mallah et al.
Circulation
Cardiac Imaging and Diagnostics
article

Abstract 4370057: Comparison of non-calcified to calcified plaque ratio versus noncalcified plaque burden to predict adverse cardiovascular outcomes in the CONFIRM2 registry

Kelley R. Branch, George Wesbey, Filippo Cademartiri, Mouaz Husayn Al-Mallah, Prashant Nagpal, Omar Khalique, Paul Knaapen, Ronald P. Karlsberg, Alexander van Rosendael, Mirvat Alasnag, Amit Pursnani, Nick S. Nurmohamed, Victor Cheng, Sabha Bhatti, Amit R. Patel, Martin Hadamitzky, Ibrahim Danad, Marly van Assen, Jim Mills, Borek Foldyna, Christoph Gräni, Ronny R. Buechel, Geoffrey Cho, Amro Alsaid, Rebecca Fisher, Jisuk Park, Rine Nakanishi, Andrew Choi, Venkateshwar Polsani, Gianluca Pontone, Roderick C. Deaño, Andrew Oehler, Matthew Jay Budoff, Carlo N. De Cecco, Saima Mushtaq, Rhanderson Cardoso, Vasileios Kamperidis, Maros Ferencik, Cristiane Carvalho Singulane, Himanshu Gupta, Vasvi Singh, Gudrun Feuchtner, Daniele Andreini, Jeroen Bax, David German, Stephen A. Bloom, Dinesh Kalra
article en

Abstract

Background: While the burden and morphological features of coronary atherosclerosis are both important drivers of major adverse cardiovascular events (MACE), there remains uncertainty about which plaque type is more likely to predispose to MACE i.e. noncalcified plaque (NCP) or calcified plaque (CP). Research question: Does NCP:CP ratio or NCP volume influence MACE in patients from the CONFIRM2 registry, an international, observational cohort study? Methods: Symptomatic patients without prior MI/revascularization referred to coronary CTA for clinical indications were included. CP and NCP volumes were determined using artificial intelligence-facilitated coronary CT (AI-QCT). The primary endpoint (MACE) was a composite of all-cause death, myocardial infarction, stroke, heart failure, late revascularization, and hospitalization for unstable angina. Results: Of the 3,551 patients (median age 59 years; 49.5% women), data were available for 3,301. A total of 250 patients with no identifiable plaque were excluded from the analysis. MACE occurred in 4.7% of patients (median f/u 51 months). Hypertension, hyperlipidemia, and smoking were present in 54.3%, 48.1%, and 14%. Statin use in 67.3%, CACS = 0 in 41.7%. 91% had NCP <250 mm 3 , 8.4% 250-750 mm 3 and 0.7% >750 mm 3 . MACE rates for tertiles of NCP:CP ratio were statistically significant (Panel A; p=0.0003): 1 st tertile (Mean NCP:CP ratio of 46%; n=1100 patients; median NCP volume = 85.6 mm 3 ; MACE rate of 5.6%); 2 nd tertile (NCP:CP 81%; n=1101; NCPvol. = 67.6 mm 3 ; 6.6%); 3 rd tertile (NCP:CP 99%; n=1100; NCPvol. = 22.3 mm 3 ; 2.9%). However, in a multivariable Cox proportional hazards model adjusted for sex and age, when adjusting also for NCP volume, the NCP:CP tertile ratio did not remain a significant predictor of MACE, p=0.115 (Model#3, Panel B). Only 9 patients had predominant CP (NCP:CP ratio<10%) while the majority had predominant NCP. Conclusions: The main driver of incident MACE was the noncalcified plaque volume (NCP) rather than the NCP:CP ratio. More data with a larger cohort of patients with relatively more CP is needed to evaluate the role of individual features of partially calcified plaques such as spotty calcification to assess if they are better predictors of MACE or whether NCP volume alone is sufficient.

CirculationVol. 152(Suppl_3)
West Virginia University (US), Brigham and Women's Hospital (US), Toho University (JP), Allegheny Health Network (US), Mount Sinai Hospital (US), NorthShore University HealthSystem (US), University of Wisconsin–Madison (US), University of Louisville (US), Innsbruck Medical University (AT), Emory University (US), University of Washington (US), Aristotle University of Thessaloniki (GR), UCLA Health (US), Leiden University Medical Center (NL), Valley Hospital (US), University Hospital of Bern (CH), Piedmont Atlanta Hospital (US), Massachusetts General Hospital (US), Centro Cardiologico Monzino (IT), St. Francis Hospital (US), University Hospital of Zurich (CH), King Fahd Armed Forces Hospital (SA), Methodist Hospital (US), Heart Hospital Baylor Plano (US), Minneapolis Heart Institute Foundation (US), Midland Heart (GB), Cedars-Sinai Smidt Heart Institute (US), National Institute of Cardiovascular Diseases (PK), Oregon Health and Science University Hospital (US), Scripps Clinic (US), Deutsches Herzzentrum München (DE), Amsterdam University Medical Centers (NL), GW Medical Faculty Associates (US), University of Virginia (US)
Openalex Percentile: Top 53%
Cardiac Imaging and Diagnostics
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