Coronary Computed Tomography Angiography-Based Coronary Risk Stratification in Subjects Presenting With No or Atypical Symptoms

Background: Coronary computed tomography angiography (CTA) findings of positive vessel remodeling and low-attenuation plaque, referred to as computed tomography-verified high-risk plaque (CT-HRP), have been reported to be associated with the development of subsequent acute coronary syndromes. The ai...

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Bibliographic Details
Published in:Circulation Journal 2012, Vol.76(10), pp.2419-2425
Main Authors: Fujimoto, Shinichiro, Kondo, Takeshi, Kodama, Takahide, Orihara, Tadaaki, Sugiyama, Junichi, Kondo, Makoto, Endo, Akira, Fukazawa, Hiroshi, Nagaoka, Hideki, Oida, Akitsugu, Ikeda, Takanori, Yamazaki, Junichi, Takase, Shinichi, Narula, Jagat
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - diagnostic imaging
Adult
Age Factors
Aged
Coronary Angiography
Coronary computed tomography angiography
Diabetes Mellitus - diagnostic imaging
Dyslipidemias - diagnostic imaging
Female
Framingham risk score
Humans
Hypertension - diagnostic imaging
Low-attenuation plaque
Male
Middle Aged
Plaque, Atherosclerotic - diagnostic imaging
Positive remodeling
Risk
Sex Factors
Smoking - adverse effects
Tomography, X-Ray Computed
Vulnerable plaque
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Summary:Background: Coronary computed tomography angiography (CTA) findings of positive vessel remodeling and low-attenuation plaque, referred to as computed tomography-verified high-risk plaque (CT-HRP), have been reported to be associated with the development of subsequent acute coronary syndromes. The aim of this study was to examine the usefulness of coronary CTA for coronary risk re-stratification of patients with asymptomatic and atypical chest symptoms. Methods and Results: A total of 1,139 subjects (M/F 602/537; mean age, 61.5±9.3 years) who were either asymptomatic or presented with atypical chest symptoms underwent coronary 64- or 320-slice multidetector computed tomography angiography and Agatston score. Age, sex, coronary risk factors, including hypertension, diabetes mellitus (DM), dyslipidemia, and smoking were investigated as predictors for CT-HRP on multivariate analysis using logistic regression analysis. CT-HRP was observed in 72 patients (6.3%). Based on Framingham risk scores (FRS), CT-HRP was observed in 0/94 subjects (0.0%) in the low-risk group, 35/806 (4.3%) in the intermediate-risk group, and 37/239 (15.5%) in the high-risk group. On logistic regression analysis significant predictors for CT-HRP in intermediate- and high-risk subjects were male sex (odds ratio [OR] 2.829; 95% confidence interval [CI] 1.460–5.479, P=0.0021), DM (OR 2.418; 95% CI 1.420–4.116, P=0.0011), and current smoking (OR 1.922; 95% CI 1.096–3.371, P=0.0160). CT-HRP prevalence for Agatston scores >500 and >250 was lower in the intermediate- and high-risk groups, respectively. Conclusions: In asymptomatic subjects and those presenting with atypical chest pain who have a more than an intermediate risk, coronary CTA is contributory to FRS. Male sex, DM and smoking were independent predictors of vulnerable plaque in the more than intermediate-risk group.  (Circ J 2012; 76: 2419–2425)
ISSN:1346-9843
1347-4820
DOI:10.1253/circj.CJ-12-0157