Additive Value of Semiautomated Quantification of Coronary Artery Disease Using Cardiac Computed Tomographic Angiography to Predict Future Acute Coronary Syndrome

被引:155
作者
Versteylen, Mathijs O. [1 ]
Kietselaer, Bas L. [1 ,2 ]
Dagnelie, Pieter C. [3 ]
Joosen, Ivo A. [1 ]
Dedic, Admir [4 ,5 ]
Raaijmakers, Rolf H. [6 ]
Wildberger, Joachim E. [2 ]
Nieman, Koen [4 ,5 ]
Crijns, Harry J. [1 ]
Niessen, Wiro J. [7 ,8 ,9 ]
Daemen, Mat J. [10 ]
Hofstra, Leonard [1 ,11 ]
机构
[1] Maastricht Univ, Med Ctr, Dept Cardiol, Cardiovasc Res Inst Maastricht, Maastricht, Netherlands
[2] Maastricht Univ, Med Ctr, Dept Radiol, Maastricht, Netherlands
[3] Maastricht Univ, CARIM CAPHRI, Dept Epidemiol, Maastricht, Netherlands
[4] Erasmus Univ, Med Ctr, Dept Cardiol, Rotterdam, Netherlands
[5] Erasmus Univ, Med Ctr, Dept Radiol, Rotterdam, Netherlands
[6] Philips Healthcare, Best, Netherlands
[7] Erasmus Univ, Med Ctr, Biomed Imaging Grp Rotterdam, Dept Med Informat, Rotterdam, Netherlands
[8] Erasmus Univ, Med Ctr, Biomed Imaging Grp Rotterdam, Dept Radiol, Rotterdam, Netherlands
[9] Delft Univ Technol, Fac Sci Appl, Delft, Netherlands
[10] Amsterdam Med Ctr, Dept Pathol, Amsterdam, Netherlands
[11] Cardiol Ctr Netherlands, Utrecht, Netherlands
关键词
acute coronary syndrome(s); cardiac computed tomography angiography; plaque characteristics quantification; prognostic value; ALL-CAUSE MORTALITY; INTERNATIONAL MULTICENTER REGISTRY; INCREMENTAL PROGNOSTIC VALUE; RADIOFREQUENCY DATA-ANALYSIS; PLAQUE ANALYSIS SOFTWARE; INTRAVASCULAR ULTRASOUND; CT ANGIOGRAPHY; ATHEROSCLEROTIC PLAQUES; NONINVASIVE ASSESSMENT; CLINICAL-OUTCOMES;
D O I
10.1016/j.jacc.2013.02.065
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives The purpose of this study was to investigate whether the use of a semiautomated plaque quantification algorithm (reporting volumetric and geometric plaque properties) provides additional prognostic value for the development of acute coronary syndromes (ACS) as compared with conventional reading from cardiac computed tomography angiography (CCTA). Background CCTA enables the visualization of coronary plaque characteristics, of which some have been shown to predict ACS. Methods A total of 1,650 patients underwent 64-slice CCTA and were followed up for ACS for a mean 26 +/- 10 months. In 25 patients who had ACS and 101 random controls (selected from 993 patients with coronary artery disease but without coronary event), coronary artery disease was evaluated using conventional reading (calcium score, luminal stenosis, morphology), and then independently quantified using semiautomated software (plaque volume, burden area [plaque area divided by vessel area times 100%], noncalcified percentage, attenuation, remodeling). Clinical risk profile was calculated with Framingham risk score (FRS). Results There were no significant differences in conventional reading parameters between controls and patients who had ACS. Semiautomated plaque quantification showed that compared to controls, ACS patients had higher total plaque volume (median: 94 mm(3) vs. 29 mm(3)) and total noncalcified volume (28 mm(3) vs. 4 mm(3), p <= 0.001 for both). In addition, per-plaque maximal volume (median: 56 mm(3) vs. 24 mm(3)), noncalcified percentage (62% vs. 26%), and plaque burden (57% vs. 36%) in ACS patients were significantly higher (p < 0.01 for all). A receiver-operating characteristic model predicting for ACS incorporating FRS and conventional CCTA reading had an area under the curve of 0.64; a second model also incorporating semiautomated plaque quantification had an area under the curve of 0.79 (p < 0.05). Conclusions The semiautomated plaque quantification algorithm identified several parameters predictive for ACS and provided incremental prognostic value over clinical risk profile and conventional CT reading. The application of this tool may improve risk stratification in patients undergoing CCTA. (C) 2013 by the American College of Cardiology Foundation
引用
收藏
页码:2296 / 2305
页数:10
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