Differences in coronary artery disease by CT angiography between patients developing unstable angina pectoris vs. major adverse cardiac events |
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Authors: | Christopher L Schlett John W Nance Jr U Joseph Schoepf Terrence X O’Brien Ullrich Ebersberger Gary F Headden Udo Hoffmann Fabian Bamberg |
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Institution: | 1. Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA;2. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA;3. The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA;4. Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;5. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany;6. Department of Cardiology and Intensive Care Medicine, Heart Centre Munich-Bogenhausen, Munich, Germany;g Department of Radiology, University of Munich, Grosshadern Campus, and Munich Heart Alliance, Munich, Germany;h Department of Radiology, University of Tuebingen, Germany |
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Abstract: | ObjectiveCT angiography (CTA) has prognostic value in patients. But it is unknown whether differences in atherosclerosis by CTA predict the development of unstable angina pectoris (UAP) vs. major adverse cardiac events (MACE).MethodsWe followed patients undergoing CTA as part of their acute chest pain work-up. Primary outcome was the development of UAP or MACE (cardiac death, myocardial infarction, revascularization) during a minimum follow-up of 12-months. CTAs were assessed for extent and composition of coronary plaque and stenosis. Ordinal regression with a 3-level outcome (no events, UAP, MACE) was applied.ResultsAmong 315 patients, 22 developed UAP and 31 MACE. While UAP patients had higher atherosclerosis burden with respect to all assessed features compared to patients with no events (p ≤ 0.02), only mixed plaque extent was significantly different between UAP and MACE patients (p = 0.02). The odds ratio was 4.55 for being in a higher disease-level comparing patients with low extent to those with no mixed plaque, and 3.02 comparing patients with high to those with low. These findings remained after adjustments for potential confounders.ConclusionThe extent of mixed coronary plaque is different between patients who develop UAP vs. MACE, supporting the hypothesis that it is a more culprit morphology. |
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Keywords: | ACS acute coronary syndrome CTA computed tomographic angiography CABG coronary artery bypass graft CAC coronary artery calcium CAD coronary artery disease ED emergency department FRS Framingham risk score HU hounsfield units IQR interquartile range MACE major adverse cardiac events MI myocardial infarction OR odds ratio UAP unstable angina pectoris |
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