Atherosclerosis quantification and cardiovascular risk: the ISCHEMIA trial

Nick S. Nurmohamed, Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
James K. Min, Cleerly, Inc, Denver, CO, USA.
Rebecca Anthopolos, New York University Grossman School of Medicine, New York, NY, USA.
Harmony R. Reynolds, New York University Grossman School of Medicine, New York, NY, USA.
James P. Earls, Cleerly, Inc, Denver, CO, USA.
Tami Crabtree, Cleerly, Inc, Denver, CO, USA.
G B. Mancini, Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.
Jonathon Leipsic, Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.
Matthew J. Budoff, Lundquist Institute, Torrance, CA, USA.
Cameron J. Hague, Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.
Sean M. O'Brien, Duke Clinical Research Institute, Durham, NC, USA.
Gregg W. Stone, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Jeffrey S. Berger, New York University Grossman School of Medicine, New York, NY, USA.
Robert Donnino, New York University Grossman School of Medicine, New York, NY, USA.
Mandeep S. Sidhu, Albany Medical College, Albany, NY, USA.
Jonathan D. Newman, New York University Grossman School of Medicine, New York, NY, USA.
William E. Boden, VA New England Healthcare System, Boston University School of Medicine, Boston, MA, USA.
Bernard R. Chaitman, St Louis University School of Medicine Center for Comprehensive Cardiovascular Care, St Louis, MO, USA.
Peter H. Stone, Brigham and Women's Hospital, Boston, MA, USA.
Sripal Bangalore, New York University Grossman School of Medicine, New York, NY, USA.
John A. Spertus, University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
Daniel B. Mark, Duke Clinical Research Institute, Durham, NC, USA.
Leslee J. Shaw, Bronfman Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Judith S. Hochman, New York University Grossman School of Medicine, New York, NY, USA.
David J. Maron, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.

Document Type

Journal Article

Publication Date

8-5-2024

Journal

European heart journal

DOI

10.1093/eurheartj/ehae471

Keywords

Artificial intelligence; Atherosclerosis; CCTA; Coronary artery disease; Ischaemia; Plaque

Abstract

BACKGROUND AND AIMS: The aim of this study was to determine the prognostic value of coronary computed tomography angiography (CCTA)-derived atherosclerotic plaque analysis in ISCHEMIA. METHODS: Atherosclerosis imaging quantitative computed tomography (AI-QCT) was performed on all available baseline CCTAs to quantify plaque volume, composition, and distribution. Multivariable Cox regression was used to examine the association between baseline risk factors (age, sex, smoking, diabetes, hypertension, ejection fraction, prior coronary disease, estimated glomerular filtration rate, and statin use), number of diseased vessels, atherosclerotic plaque characteristics determined by AI-QCT, and a composite primary outcome of cardiovascular death or myocardial infarction over a median follow-up of 3.3 (interquartile range 2.2-4.4) years. The predictive value of plaque quantification over risk factors was compared in an area under the curve (AUC) analysis. RESULTS: Analysable CCTA data were available from 3711 participants (mean age 64 years, 21% female, 79% multivessel coronary artery disease). Amongst the AI-QCT variables, total plaque volume was most strongly associated with the primary outcome (adjusted hazard ratio 1.56, 95% confidence interval 1.25-1.97 per interquartile range increase [559 mm3]; P = .001). The addition of AI-QCT plaque quantification and characterization to baseline risk factors improved the model's predictive value for the primary outcome at 6 months (AUC 0.688 vs. 0.637; P = .006), at 2 years (AUC 0.660 vs. 0.617; P = .003), and at 4 years of follow-up (AUC 0.654 vs. 0.608; P = .002). The findings were similar for the other reported outcomes. CONCLUSIONS: In ISCHEMIA, total plaque volume was associated with cardiovascular death or myocardial infarction. In this highly diseased, high-risk population, enhanced assessment of atherosclerotic burden using AI-QCT-derived measures of plaque volume and composition modestly improved event prediction.

Department

Radiology

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