High-risk plaque detected by serial computed tomography angiography (CTA) is an independent predictor of acute coronary syndrome (ACS), according to the results of study published July 20 in the Journal of the American College of Cardiology (JACC).

The study, led by Sadako Motoyama, MD, PhD; Jagat Narula, MD, PhD, MACC, editor-in-chief of JACC: Cardiovascular Interventions; et al., evaluated whether the development of ACS during mid-term follow-up could be predicted by CTA-verified plaque characteristics. Researchers assessed the outcomes in 3,158 patients who underwent CTA for suspected or known coronary artery disease at a mean follow-up of 3.9 years.

The results of the study showed that CTA-verified high-risk plaque and plaque progression were both independent predictors for the development of ACS. ACS occurred in 88 patients, 48 of whom were positive for high-risk plaque. The authors note that “the plaques that progressed over time on a volumetric basis and evolved from [non-high-risk plaque to high-risk] were the ones more likely to result in ACS.”

Moving forward, they add that “randomized trials are needed to compare the clinical outcomes associated with pharmacological and mechanical interventions in patients with nonobstructive, high-risk coronary plaque morphology.”

Eugene Braunwald, MD, MACC, noted in an accompanying editorial comment, that the current study expands the earlier assessment of coronary arteries by CTA. “Not surprisingly, ACS occurred 10 times more frequently in patients with than in those without high-risk plaques. Because the former were present in only 9.3 percent of the patients, the actual number of patients developing ACS from these two groups was almost identical...” He concludes that, “Therefore, if a therapeutic intervention were carried out in only the patients with high-risk plaques, the incidence of the development or recurrence of ACS could, at best, be reduced by one-half.”

Listen to the audio commentary by Valentin Fuster, MD, PhD, MACC, editor-in-chief of JACC.

Keywords: Acute Coronary Syndrome, Angiography, Coronary Artery Disease, Disease Progression, Incidence, Plaque, Atherosclerotic, Recurrence, Tomography

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