Plaque burden and one-year outcomes in patients with acute chest pain: Results from the multicenter Rapid Assessment of Potential Ischemic heart Disease with CT Coronary Angiography trial

Mohammed N Meah, Evangelos Tzolos, Kang-Ling Wang, Anda Bularga, Marc R Dweck, Nick Curzen, Attila Kardos, Liza Keating, Robert F Storey, Nicholas L Mills, Piotr J Slomka, Damini Dey, David E Newby, Alasdair Gray, Michelle C Williams, Carl A. Roobottom*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To determine whether plaque burden and characteristics can predict subsequent death or myocardial infarction in patients with acute chest pain.
Background: In patients with stable chest pain, computed tomography (CT) plaque burden is an independent predictor of future coronary events.
Methods: In a post-hoc analysis of a multicenter trial of early coronary CT angiography, we performed quantitative plaque analysis to assess the association between primary endpoint of 1-year all-cause death or non-fatal myocardial infarction and the GRACE score, presence of obstructive coronary artery disease and plaque burden in 404 patients with suspected acute coronary syndrome.
Results: Following the index event, 25 patients had a primary event which was associated with a higher GRACE score (134±44 versus 113±35; p=0.012), larger burdens of total (46% [43-50] versus 36% [21-46]; p<0.001), non-calcified (41% [37-47] versus 33% [20-41]; p<0.001) and low-attenuation plaque (4.22% [3.3-5.68] versus 2.14% [0.5-4.88]; p<0.001), but not obstructive coronary artery disease (p=0.065). Total, non-calcified and low-attenuation plaque burden were the strongest predictors of future events independent of GRACE score and obstructive coronary artery disease (p≤0.002 for all). Patients with a low-attenuation burden above the median had nearly an 8-fold increased risk of the primary endpoint (hazard ratio (HR) 7.80 [95% CI 2.33-26.0], p<0.001), outperforming either a GRACE score of >140 (HR 3.80 [95% CI 1.45-6.98], p=0.004) or obstructive coronary artery disease (HR 2.07 [95% CI 0.94-4.53], p=0.07).
Conclusion: In patients with suspected acute coronary syndrome, low-attenuation plaque burden is a major predictor of 1-year death or recurrent myocardial infarction.
Original languageEnglish
JournalJACC: Cardiovascular Imaging
Early online date15 Jun 2022
DOIs
Publication statusE-pub ahead of print - 15 Jun 2022

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