A clinical model to identify patients with high-risk plaque by coronary computed tomography angiography. (1st February 2017)

• Record Type: Journal Article
• Authors: Tomizawa, Nobuo; Yamamoto, Kodai; Hayakawa, Yayoi; Inoh, Shinichi; Nojo, Takeshi; Nakamura, Sunao
• Is Part Of: International journal of cardiology. Volume 228(2017)
• Page Start: 260
• Page End: 264
• Publication Date: 2017-02-01
• Subjects: Clinical model -- Coronary CT angiography -- High-risk plaque -- Low attenuation -- Napkin ring sign -- Positive remodeling; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.11.248
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Objectives: Current clinical models predict the pre-test probability of obstructive coronary artery disease, but these models do not predict the presence of high-risk plaques. Thus the objective of this study was to propose a model to predict high-risk plaque assessed by coronary computed tomography (CT) angiography. Methods: This study was a retrospective cross-sectional study. A clinical model was derived from 2392 patients and verified by 733 patients who underwent coronary CT suspected of coronary artery disease. High-risk plaque was defined as a plaque with positive remodeling (remodeling index > 1.1), low attenuation (< 30 Hounsfield units) and napkin-ring sign. The risk score was calculated from the following 6 variables with a maximum of 24 points: age, sex, hemoglobin A1c, systolic blood pressure, high-density lipoprotein and smoking status. Results: The proportion of patients with high-risk plaque was 11% and 17% in the derivation and validation cohort, respectively. The area under the receiver operation characteristic curve was 0.71 (95% confidence interval (CI): 0.68 to 0.74) in the derivation cohort and 0.75 (95% CI: 0.70 to 0.79) in the validation cohort. The frequency of high-risk plaques was 4% in the low-risk group (≤ 8 points) while it was 53% in the high-risk group (≥ 17 points) of the derivation cohort. Conclusions: We propose a scoring system to detect high-risk plaque assessed by coronary CT. Patients in the high-risk group have a high prevalence of high-risk plaque and might benefit from lipid lowering therapy. Highlights: We propose a new model to predict high-risk plaque assessed by CT. The model was robust with an AUC of 0.75. About half of patients in the high-risk group had high-risk plaques. Patients in the high-risk group might benefit from lipid lowering therapy.