Coronary artery plaque characteristics associated with adverse outcomes in the SCOT-HEART study. Link to paper on Journal of the American College of Cardiology. Authors Michelle C. Williams, Alastair J. Moss, Marc Dweck, Philip D. Adamson, Shirjel Alam, Amanda Hunter, Anoop S.V. Shah, Tania Pawade, Jonathan R. Weir-McCall, Giles Roditi, Edwin J.R. van Beek, David E. Newby and Edward D. Nicol Abstract Image 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) Keywords Atherosclerotic plaque Computed tomography (CT) Coronary angiography Coronary artery disease Related links Link to paper on Journal of the American College of Cardiology Link to SCOT-HEART publication Dr Michelle Williams Dr Alastair Moss Dr Marc Dweck Dr Philip Adamson Dr Anoop Shah Dr Tania Pawade Prof Edwin van Beek Prof David Newby Publication date 22 Jan, 2019
