CCTA-Derived Coronary Plaque Burden Offers Enhanced Prognostic Value Over CAC Scoring In Suspected CAD Patients
Document Type
Journal Article
Publication Date
3-25-2025
Journal
European heart journal. Cardiovascular Imaging
DOI
10.1093/ehjci/jeaf093
Abstract
AIM: To assess the prognostic utility of coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA) - derived quantitative plaque metrics for predicting adverse cardiovascular outcomes. METHODS AND RESULTS: The study enrolled 2,404 patients with suspected CAD but without prior history of CAD. All participants underwent CAC scoring and CCTA, with plaque metrics quantified using an artificial intelligence (AI)-based tool (Cleerly, Inc). Percent atheroma volume (PAV) and non-calcified plaque volume percentage (NCPV%), reflecting total plaque burden and the proportion of non-calcified plaque volume normalized to vessel volume, were evaluated. The primary endpoint was a composite of all-cause mortality and non-fatal myocardial infarction (MI). Cox proportional hazards models, adjusted for clinical risk factors and early revascularization, were employed for analysis.During a median follow-up of 7.0 years, 208 patients (8.7%) experienced the primary endpoint, including 73 cases of MI (3%). The model incorporating PAV demonstrated superior discriminatory power for the composite endpoint (AUC = 0.729) compared to CAC scoring (AUC = 0.706, p = 0.016). In MI prediction, PAV (AUC = 0.791) significantly outperformed CAC (AUC = 0.699, p < 0.001), with NCPV% showing the highest prognostic accuracy (AUC = 0.814, p < 0.001). CONCLUSIONS: AI-driven assessment of coronary plaque burden enhances prognostic accuracy for future adverse cardiovascular events, highlighting the critical role of comprehensive plaque characterization in refining risk stratification strategies.
APA Citation
Dahdal, Jorge; Jukema, Ruurt A.; Maaniitty, Teemu; Nurmohamed, Nick S.; Raijmakers, Pieter G.; Hoek, Roel; Driessen, Roel S.; Twisk, Jos W.; Bär, Sara; Planken, R Nils; van Royen, Niels; Nijveldt, Robin; Bax, Jeroen J.; Saraste, Antti; van Rosendael, Alexander R.; Knaapen, Paul; Knuuti, Juhani; and Danad, Ibrahim, "CCTA-Derived Coronary Plaque Burden Offers Enhanced Prognostic Value Over CAC Scoring In Suspected CAD Patients" (2025). GW Authored Works. Paper 6759.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6759
Department
School of Medicine and Health Sciences Resident Works