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Coronary Atherosclerotic Precursors of Acute Coronary Syndromes
Chang, Hyuk-Jae,Lin, Fay Y.,Lee, Sang-Eun,Andreini, Daniele,Bax, Jeroen,Cademartiri, Filippo,Chinnaiyan, Kavitha,Chow, Benjamin J.W.,Conte, Edoardo,Cury, Ricardo C.,Feuchtner, Gudrun,Hadamitzky, Marti Elsevier 2018 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY - Vol.71 No.22
<P><B>Abstract</B></P> <P><B>Background</B></P> <P>The association of atherosclerotic features with first acute coronary syndromes (ACS) has not accounted for plaque burden.</P> <P><B>Objectives</B></P> <P>The purpose of this study was to identify atherosclerotic features associated with precursors of ACS.</P> <P><B>Methods</B></P> <P>We performed a nested case-control study within a cohort of 25,251 patients undergoing coronary computed tomographic angiography (CTA) with follow-up over 3.4 ± 2.1 years. Patients with ACS and nonevent patients with no prior coronary artery disease (CAD) were propensity matched 1:1 for risk factors and coronary CTA–evaluated obstructive (≥50%) CAD. Separate core laboratories performed blinded adjudication of ACS and culprit lesions and quantification of baseline coronary CTA for percent diameter stenosis (%DS), percent cross-sectional plaque burden (PB), plaque volumes (PVs) by composition (calcified, fibrous, fibrofatty, and necrotic core), and presence of high-risk plaques (HRPs).</P> <P><B>Results</B></P> <P>We identified 234 ACS and control pairs (age 62 years, 63% male). More than 65% of patients with ACS had nonobstructive CAD at baseline, and 52% had HRP. The %DS, cross-sectional PB, fibrofatty and necrotic core volume, and HRP increased the adjusted hazard ratio (HR) of ACS (1.010 per %DS, 95% confidence interval [CI]: 1.005 to 1.015; 1.008 per percent cross-sectional PB, 95% CI: 1.003 to 1.013; 1.002 per mm<SUP>3</SUP> fibrofatty plaque, 95% CI: 1.000 to 1.003; 1.593 per mm<SUP>3</SUP> necrotic core, 95% CI: 1.219 to 2.082; all p < 0.05). Of the 129 culprit lesion precursors identified by coronary CTA, three-fourths exhibited <50% stenosis and 31.0% exhibited HRP.</P> <P><B>Conclusions</B></P> <P>Although ACS increases with %DS, most precursors of ACS cases and culprit lesions are nonobstructive. Plaque evaluation, including HRP, PB, and plaque composition, identifies high-risk patients above and beyond stenosis severity and aggregate plaque burden.</P> <P><B>Central Illustration</B></P> <P>[DISPLAY OMISSION]</P>
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