Association of coronary artery calcium score with qualitatively and quantitatively assessed adverse plaque on coronary CT angiography in the SCOT-HEART trial . (16th September 2021)

• Record Type: Journal Article
• Authors: Osborne-Grinter, Maia; Kwiecinski, Jacek; Doris, Mhairi; McElhinney, Priscilla; Cadet, Sebastien; Adamson, Philip D; Moss, Alastair J; Alam, Shirjel; Hunter, Amanda; Shah, Anoop S V; Mills, Nicholas L; Pawade, Tania; Wang, Chengjia; Weir-McCall, Jonathan R; Roditi, Giles; van Beek, Edwin J R; Shaw, Leslee J; Nicol, Edward D; Berman, Daniel; Slomka, Piotr J; Newby, David E; Dweck, Marc R; Dey, Damini; Williams, Michelle C
• Is Part Of: European heart journal. Volume 23:Number 9(2022)
• Page Start: 1210
• Page End: 1221
• Publication Date: 2021-09-16
• Subjects: coronary calcium score -- low-attenuation plaque -- computed tomography -- computed tomography coronary angiography -- atherosclerotic plaque; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeab135
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Aims: Coronary artery calcification is a marker of cardiovascular risk, but its association with qualitatively and quantitatively assessed plaque subtypes is unknown. Methods and results: In this post-hoc analysis, computed tomography (CT) images and 5-year clinical outcomes were assessed in SCOT-HEART trial participants. Agatston coronary artery calcium score (CACS) was measured on non-contrast CT and was stratified as zero (0 Agatston units, AU), minimal (1–9 AU), low (10–99 AU), moderate (100–399 AU), high (400–999 AU), and very high (≥1000 AU). Adverse plaques were investigated by qualitative (visual categorization of positive remodelling, low-attenuation plaque, spotty calcification, and napkin ring sign) and quantitative (calcified, non-calcified, low-attenuation, and total plaque burden; Autoplaque) assessments. Of 1769 patients, 36% had a zero, 9% minimal, 20% low, 17% moderate, 10% high, and 8% very high CACS. Amongst patients with a zero CACS, 14% had non-obstructive disease, 2% had obstructive disease, 2% had visually assessed adverse plaques, and 13% had low-attenuation plaque burden >4%. Non-calcified and low-attenuation plaque burden increased between patients with zero, minimal, and low CACS ( P < 0.001), but there was no statistically significant difference between those with medium, high, and very high CACS. Myocardial infarction occurred in 41 patients, 10% of whom had zero CACS. CACS >1000 AU and low-attenuation plaque burden were the only predictors of myocardial infarction, independent of obstructive disease, and 10-year cardiovascular risk score. Conclusion: In patients with stable chest pain, zero CACS is associated with a good but not perfect prognosis, and CACS cannot rule out obstructive coronary artery disease, non-obstructive plaque, or adverse plaque phenotypes, including low-attenuation plaque. Graphical Abstract: