Quantitative Evaluation of Coronary Plaque Progression by Computed Tomographic Angiography

Abstract

C oronary artery disease (CAD), which causes more than 20 million deaths each year, is the world's leading cause of morbidity and death.1,2 Most patients with CAD have many coronary obstructions that are in varying degrees of progression and that pose different risks.3-6 Therefore, understanding the progression of coronary plaque would help physicians make more informed decisions about whether and how to treat patients at risk for CAD.In clinical studies, intravascular ultrasound (IVUS) has traditionally been used to investigate the composition and progression of coronary plaques in the proximal or mid segments of one or 2 major coronary vessels. 7,8 However, it is not appropriate for routine serial evaluations because it carries a small risk of severe procedural complications. In contrast, computed tomographic angiography (CTA) is less expensive and noninvasive. Advances in computed tomographic (CT) technology and post-imageprocessing techniques have made it possible not only to detect stenosis with coronary CTA, but also to use it to quantitatively analyze coronary plaques. [9][10][11][12][13] In recent years, a few serial studies with CTA have appeared in the literature, 14-17 but most of them have focused on lesions in diseased segments of the coronary tree. Our objective in this study was to use CTA to examine the natural history of coronary atherosclerosis along the full length of the right coronary artery (RCA) tree and to investigate serial changes in the minimum luminal area (MLA), plaque burden (PB), plaque volume (PV), and arterial remodeling. Patients and MethodsTwenty-one patients treated at Beijing Anzhen Hospital from 2010 through 2013 were studied retrospectively (Table I). Inclusion criteria were as follows: age >18 years, availability of 2 coronary CTA scans taken >6 months apart, and diagnosis of acute coronary syndrome (ACS) during the initial physical examination. Exclusion criteria included previous percutaneous coronary intervention (PCI) to the RCA or coronary artery bypass grafting, severe valvular heart disease, irregular heart rhythm, renal fail-

Predictive value of coronary artery calcium score in cardiovascular disease

“…Moreover, a 1≤CACS≤100 yielded similar CHD and CVD rates. These findings indicated that plaque or coronary artery calcium burden may impact CHD events in individuals at extreme traditional risk (26). One possible explanation for these findings could be that, due to the long follow-up period, participants had CVD events more than had CHD events with a CACS of 0 ( 33).…”

“…The subgroup analysis and random effects models were Traditional results showed that the CACS has been viewed as a marker to primarily determine the CHD risk given that the location of the calcification is in the coronary arterial bed and, because of the dynamic nature of atherosclerosis, serial alterations in CACS might reflect progression of atherosclerosis, providing an additional prognostic value (1, [22][23][24]. CACS, determined by non-contrast CT (23), is an excellent overall measure of coronary atherosclerotic burden and provides information on plaque prognosis (13) that is generally highly incremental over traditional risk factors (25) and clinical risk prediction schemes (26,27). A CHD event is defined as myocardial infarction, death from CHD, resuscitated from cardiac arrest or definite angina, and revascularization in case of adjudicated preceding or concurrent angina.…”

“…The coronary artery calcium score (CACS), detected by computed tomography (CT), has been © 1996-2020 applied for more than 20 years to provide an early diagnosis for coronary artery disease (CAD) in clinical routine practice and is useful in predicting future cardiac events (1-5) and subclinical atherosclerosis (2). CACS, as assessed by non-contrast coronary CT angiography, which identifies ruptured and vulnerable plaques with good specificity (13,23), is an excellent overall measure of coronary atherosclerotic burden that is generally highly incremental over traditional risk factors (25) and clinical risk prediction schemes (26,27). Early detection of vulnerable plaques is important in the prevention and treatment of coronary heart disease (CHD) (7).…”