TY - JOUR
T1 - Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions
T2 - the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study
AU - Lee, Sang Eun
AU - Sung, Ji Min
AU - Andreini, Daniele
AU - Al-Mallah, Mouaz H.
AU - Budoff, Matthew J.
AU - Cademartiri, Filippo
AU - Chinnaiyan, Kavitha
AU - Choi, Jung Hyun
AU - Chun, Eun Ju
AU - Conte, Edoardo
AU - Gottlieb, Ilan
AU - Hadamitzky, Martin
AU - Kim, Yong Jin
AU - Lee, Byoung Kwon
AU - Leipsic, Jonathon A.
AU - Maffei, Erica
AU - Marques, Hugo
AU - de Araújo Gonçalves, Pedro
AU - Pontone, Gianluca
AU - Shin, Sanghoon
AU - Stone, Peter H.
AU - Samady, Habib
AU - Virmani, Renu
AU - Narula, Jagat
AU - Berman, Daniel S.
AU - Shaw, Leslee J.
AU - Bax, Jeroen J.
AU - Lin, Fay Y.
AU - Min, James K.
AU - Chang, Hyuk Jae
N1 - Publisher Copyright:
© 2020, Springer Nature B.V.
PY - 2020/12
Y1 - 2020/12
N2 - To determine whether the assessment of individual plaques is superior in predicting the progression to obstructive coronary artery disease (CAD) on serial coronary computed tomography angiography (CCTA) than per-patient assessment. From a multinational registry of 2252 patients who underwent serial CCTA at a ≥ 2-year inter-scan interval, patients with only non-obstructive lesions at baseline were enrolled. CCTA was quantitatively analyzed at both the per-patient and per-lesion level. Models predicting the development of an obstructive lesion at follow up using either the per-patient or per-lesion level CCTA measures were constructed and compared. From 1297 patients (mean age 60 ± 9 years, 43% men) enrolled, a total of 3218 non-obstructive lesions were identified at baseline. At follow-up (inter-scan interval: 3.8 ± 1.6 years), 76 lesions (2.4%, 60 patients) became obstructive, defined as > 50% diameter stenosis. The C-statistics of Model 1, adjusted only by clinical risk factors, was 0.684. The addition of per-patient level total plaque volume (PV) and the presence of high-risk plaque (HRP) features to Model 1 improved the C-statistics to 0.825 [95% confidence interval (CI) 0.823–0.827]. When per-lesion level PV and the presence of HRP were added to Model 1, the predictive value of the model improved the C-statistics to 0.895 [95% CI 0.893–0.897]. The model utilizing per-lesion level CCTA measures was superior to the model utilizing per-patient level CCTA measures in predicting the development of an obstructive lesion (p < 0.001). Lesion-level analysis of coronary atherosclerotic plaques with CCTA yielded better predictive power for the development of obstructive CAD than the simple quantification of total coronary atherosclerotic burden at a per-patient level. Clinical Trial Registration: ClinicalTrials.gov
AB - To determine whether the assessment of individual plaques is superior in predicting the progression to obstructive coronary artery disease (CAD) on serial coronary computed tomography angiography (CCTA) than per-patient assessment. From a multinational registry of 2252 patients who underwent serial CCTA at a ≥ 2-year inter-scan interval, patients with only non-obstructive lesions at baseline were enrolled. CCTA was quantitatively analyzed at both the per-patient and per-lesion level. Models predicting the development of an obstructive lesion at follow up using either the per-patient or per-lesion level CCTA measures were constructed and compared. From 1297 patients (mean age 60 ± 9 years, 43% men) enrolled, a total of 3218 non-obstructive lesions were identified at baseline. At follow-up (inter-scan interval: 3.8 ± 1.6 years), 76 lesions (2.4%, 60 patients) became obstructive, defined as > 50% diameter stenosis. The C-statistics of Model 1, adjusted only by clinical risk factors, was 0.684. The addition of per-patient level total plaque volume (PV) and the presence of high-risk plaque (HRP) features to Model 1 improved the C-statistics to 0.825 [95% confidence interval (CI) 0.823–0.827]. When per-lesion level PV and the presence of HRP were added to Model 1, the predictive value of the model improved the C-statistics to 0.895 [95% CI 0.893–0.897]. The model utilizing per-lesion level CCTA measures was superior to the model utilizing per-patient level CCTA measures in predicting the development of an obstructive lesion (p < 0.001). Lesion-level analysis of coronary atherosclerotic plaques with CCTA yielded better predictive power for the development of obstructive CAD than the simple quantification of total coronary atherosclerotic burden at a per-patient level. Clinical Trial Registration: ClinicalTrials.gov
UR - http://www.scopus.com/inward/record.url?scp=85089248654&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85089248654&partnerID=8YFLogxK
U2 - 10.1007/s10554-020-01960-z
DO - 10.1007/s10554-020-01960-z
M3 - Article
C2 - 32779077
AN - SCOPUS:85089248654
SN - 1569-5794
VL - 36
SP - 2357
EP - 2364
JO - International Journal of Cardiovascular Imaging
JF - International Journal of Cardiovascular Imaging
IS - 12
ER -