Original Investigation
Coronary Artery Plaque Characteristics Associated With Adverse Outcomes in the SCOT-HEART Study

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Abstract

Background

Unlike most noninvasive imaging modalities, coronary computed tomography angiography can characterize subtypes of atherosclerotic plaque.

Objectives

The purpose of this study was to investigate the prognostic implications of adverse coronary plaque characteristics in patients with suspected coronary artery disease.

Methods

In this SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) post hoc analysis, the presence of adverse plaque (positive remodeling or low attenuation plaque), obstructive disease, and coronary artery calcification within 15 coronary segments was assessed on coronary computed tomography angiography of 1,769 patients who were followed-up for 5 years.

Results

Among study participants (mean age 58 ± 10 years; 56% male), 608 (34%) patients had 1 or more adverse plaque features. Coronary heart disease death or nonfatal myocardial infarction was 3 times more frequent in patients with adverse plaque (n = 25 of 608 [4.1%] vs. n = 16 of 1,161 [1.4%]; p < 0.001; hazard ratio [HR]: 3.01; 95% confidence interval (CI): 1.61 to 5.63; p = 0.001) and was twice as frequent in those with obstructive disease (n = 22 of 452 [4.9%] vs. n = 16 of 671 [2.4%]; p = 0.024; HR: 1.99; 95% CI: 1.05 to 3.79; p = 0.036). Patients with both obstructive disease and adverse plaque had the highest event rate, with a 10-fold increase in coronary heart disease death or nonfatal myocardial infarction compared with patients with normal coronary arteries (HR: 11.50; 95% CI: 3.39 to 39.04; p < 0.001). However, these associations were not independent of coronary artery calcium score, a surrogate measure of coronary plaque burden.

Conclusions

Adverse coronary plaque characteristics and overall calcified plaque burden confer an increased risk of coronary heart disease death or nonfatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590)

Key Words

atherosclerotic plaque
computed tomography
coronary angiography
coronary artery disease

Abbreviations and Acronyms

AU
Agatston units
CI
confidence interval
CT
computed tomography
CTA
computed tomography angiography
HR
hazard ratio
IQR
interquartile range

Cited by (0)

This trial was funded by The Chief Scientist Office of the Scottish Government Health and Social Care Directorates (CZH/4/588), with supplementary awards from the British Heart Foundation (RE/13/3/30183), Edinburgh and Lothian’s Health Foundation Trust and the Heart Diseases Research Fund. The Royal Bank of Scotland supported the provision of 320-multidetector CT for NHS Lothian and the University of Edinburgh. The Edinburgh Imaging facility QMRI (Edinburgh) is supported by the National Health Service Research Scotland (NRS) through National Health Service Lothian Health Board. The Clinical Research Facility Glasgow and Clinical Research Facility Tayside are supported by the NRS. Drs. Williams (FS/11/014) and Newby (CH/09/002, RE/13/3/30183) are supported by the British Heart Foundation. Dr. Williams (FS/11/014) is supported by The Chief Scientist Office of the Scottish Government Health (PCL/17/04). Drs. Williams and Nicol have served as consultants for GE Healthcare. Dr. Dweck is supported by the British Heart Foundation (FS/14/78/31020) and the Sir Jules Thorn Biomedical Research Award 2015 (15/JTA). Dr. Roditi has received honoraria from Bracco, Bayer-Schering, GE Healthcare, and Guerbet, which produce contrast media. Drs. Roditi, van Beek, and Newby have received honoraria and consultancy from Toshiba Medical Systems. Dr. van Beek is supported by the Scottish Imaging Network: A Platform of Scientific Excellence. Dr. Newby has received a Wellcome Trust Senior Investigator Award (WT103782AIA). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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