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Coronary Atherosclerotic Precursors of Acute Coronary Syndromes.

  • Author(s): Chang, Hyuk-Jae
  • Lin, Fay Y
  • Lee, Sang-Eun
  • Andreini, Daniele
  • Bax, Jeroen
  • Cademartiri, Filippo
  • Chinnaiyan, Kavitha
  • Chow, Benjamin JW
  • Conte, Edoardo
  • Cury, Ricardo C
  • Feuchtner, Gudrun
  • Hadamitzky, Martin
  • Kim, Yong-Jin
  • Leipsic, Jonathon
  • Maffei, Erica
  • Marques, Hugo
  • Plank, Fabian
  • Pontone, Gianluca
  • Raff, Gilbert L
  • van Rosendael, Alexander R
  • Villines, Todd C
  • Weirich, Harald G
  • Al'Aref, Subhi J
  • Baskaran, Lohendran
  • Cho, Iksung
  • Danad, Ibrahim
  • Han, Donghee
  • Heo, Ran
  • Lee, Ji Hyun
  • Rivzi, Asim
  • Stuijfzand, Wijnand J
  • Gransar, Heidi
  • Lu, Yao
  • Sung, Ji Min
  • Park, Hyung-Bok
  • Berman, Daniel S
  • Budoff, Matthew J
  • Samady, Habib
  • Shaw, Leslee J
  • Stone, Peter H
  • Virmani, Renu
  • Narula, Jagat
  • Min, James K
  • et al.
Abstract

BACKGROUND:The association of atherosclerotic features with first acute coronary syndromes (ACS) has not accounted for plaque burden. OBJECTIVES:The purpose of this study was to identify atherosclerotic features associated with precursors of ACS. METHODS:We performed a nested case-control study within a cohort of 25,251 patients undergoing coronary computed tomographic angiography (CTA) with follow-up over 3.4 ± 2.1 years. Patients with ACS and nonevent patients with no prior coronary artery disease (CAD) were propensity matched 1:1 for risk factors and coronary CTA-evaluated obstructive (≥50%) CAD. Separate core laboratories performed blinded adjudication of ACS and culprit lesions and quantification of baseline coronary CTA for percent diameter stenosis (%DS), percent cross-sectional plaque burden (PB), plaque volumes (PVs) by composition (calcified, fibrous, fibrofatty, and necrotic core), and presence of high-risk plaques (HRPs). RESULTS:We identified 234 ACS and control pairs (age 62 years, 63% male). More than 65% of patients with ACS had nonobstructive CAD at baseline, and 52% had HRP. The %DS, cross-sectional PB, fibrofatty and necrotic core volume, and HRP increased the adjusted hazard ratio (HR) of ACS (1.010 per %DS, 95% confidence interval [CI]: 1.005 to 1.015; 1.008 per percent cross-sectional PB, 95% CI: 1.003 to 1.013; 1.002 per mm3 fibrofatty plaque, 95% CI: 1.000 to 1.003; 1.593 per mm3 necrotic core, 95% CI: 1.219 to 2.082; all p < 0.05). Of the 129 culprit lesion precursors identified by coronary CTA, three-fourths exhibited <50% stenosis and 31.0% exhibited HRP. CONCLUSIONS:Although ACS increases with %DS, most precursors of ACS cases and culprit lesions are nonobstructive. Plaque evaluation, including HRP, PB, and plaque composition, identifies high-risk patients above and beyond stenosis severity and aggregate plaque burden.

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