Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study
Articolo
Data di Pubblicazione:
2020
Citazione:
Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study / S. Lee, J.M. Sung, D. Andreini, M.H. Al-Mallah, M.J. Budoff, F. Cademartiri, K. Chinnaiyan, J.H. Choi, E.J. Chun, E. Conte, I. Gottlieb, M. Hadamitzky, Y.J. Kim, B.K. Lee, J.A. Leipsic, E. Maffei, H. Marques, P. de Araújo Gonçalves, G. Pontone, S. Shin, P.H. Stone, H. Samady, R. Virmani, J. Narula, D.S. Berman, L.J. Shaw, J.J. Bax, F.Y. Lin, J.K. Min, H. Chang. - In: THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING. - ISSN 1875-8312. - 36:12(2020 Dec), pp. 2357-2364. [10.1007/s10554-020-01960-z]
Abstract:
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.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Coronary artery atherosclerosis; Coronary artery disease; Coronary computed tomography angiography; Statins
Elenco autori:
S. Lee, J.M. Sung, D. Andreini, M.H. Al-Mallah, M.J. Budoff, F. Cademartiri, K. Chinnaiyan, J.H. Choi, E.J. Chun, E. Conte, I. Gottlieb, M. Hadamitzky, Y.J. Kim, B.K. Lee, J.A. Leipsic, E. Maffei, H. Marques, P. de Araújo Gonçalves, G. Pontone, S. Shin, P.H. Stone, H. Samady, R. Virmani, J. Narula, D.S. Berman, L.J. Shaw, J.J. Bax, F.Y. Lin, J.K. Min, H. Chang
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