Log in to MyACC
Geometric Plaque Characteristics and Risk of Future ACS
Quick Takes
- Adverse geometric characteristics are more frequently seen in precursor culprit coronary artery lesions in patients with ACS than in controls without ACS.
- Adverse geometric characteristics may identify coronary lesions at increased risk of future ACS incremental to stenosis severity and adverse plaque characteristics.
Study Questions:
Are adverse geometric characteristics (AGCs) of coronary lesions on coronary computed tomography angiography (CCTA) associated with increased future acute coronary syndromes (ACS)?
Methods:
This substudy of the ICONIC (Incident Coronary Syndromes Identified by CT) multicenter nested case-control study evaluated patients with ACS and a precursor culprit lesion on CT in comparison to propensity score-matched controls without ACS. Patients with ACS versus controls were evaluated for the presence of three potential AGCs: distance from coronary ostium to lesion, location at vessel bifurcation, and vessel tortuosity.
Results:
There were 116 precursor culprit lesions identified in 116 patients with ACS compared to 116 control patients. Precursor culprit lesions (compared to nonculprit lesions) had shorter distances from the coronary ostium (median 35.1 mm vs. 44.5 mm), were more frequently at bifurcations (73.3% vs. 38.9%), and had more tortuous segments (4.3% vs. 1.4%) (p < 0.05 for each). On multivariable analysis, the presence of 1 AGC (hazard ratio, 2.9; 95% confidence interval, 1.4-6.1; p = 0.005) or ≥2 AGCs (hazard ratio, 6.8; 95% confidence interval, 3.3-14.0; p < 0.001) were associated with greater future ACS. AGCs provided incremental value to discriminate culprit lesion precursors to a model that included stenosis severity, adverse plaque characteristics, and quantitative plaque characteristics (area under the curve 0.77 vs. 0.73).
Conclusions:
AGCs are more frequently seen in precursor culprit coronary artery lesions than in controls and may identify increased risk of future ACS.
Perspective:
Identifying patients at risk of future ACS remains an important goal in cardiology. We have significant evidence that adverse plaque characteristics on CT may identify patients at increased risk of ACS incremental to stenosis severity and patient risk factors. This study evaluates the relationship of specific AGCs expected to be associated with increased shear wall stress and altered coronary hemodynamics that may identify lesions at increased risk of ACS. In comparison to stenosis severity and adverse plaque characteristics alone, these three AGCs (more proximal location, located at bifurcation, and increased tortuosity) were found to have incremental prognostic value for identification of precursor culprit lesions. These AGCs are relatively straightforward to assess and are obtained on standard CCTA studies. Limitations of this study include its case-control design and the potential for selection bias and unmeasured confounding variables. Future prospective studies are needed to confirm the potential relationship between AGCs and subsequent ACS.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Cardiac Surgery and Arrhythmias, Interventions and ACS, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging
Keywords: Acute Coronary Syndrome, Angiography, Cardiac Surgical Procedures, Coronary Stenosis, Computed Tomography Angiography, Constriction, Pathologic, Diagnostic Imaging, Hemodynamics, Myocardial Ischemia, Plaque, Atherosclerotic, Risk Factors, Secondary Prevention, Tomography
< Back to Listings
