Abstract 4144554: Revascularization of Patients with Low-Density Non-Calcified Plaque was Associated with Lower Occurrence of Acute Coronary Syndrome
Authors: Shant Malkasian, Logan Hubbard, Nick Nurmohamed, Hyuk-Jae Chang, Andrew Choi, Hugo Marques, Alexander Van Rosendael, Benjamin Chow, Daniele Andreini, Edoardo Conte, Erica Maffei, Fabian Plank, Gianluca Pontone, Gudrun Feuchtner, Habib Samady, Hyung-Bok Park, Ibrahim Danad, Iksung Cho, Jeroen Bax, Ji Hyun Lee, Lohendran Baskaran, Martin Hadamitzky, Matthew Budoff, Peter Stone, Ran Heo, Ricardo Cury, Sang-Eun Lee, Subhi Al'Aref, Wijnand Stuijfzand, yao lu, Yong-Jin Kim, Filippo Cademartiri, Renu Virmani, Jagat Narula, Asim Rizvi, Kavitha Chinnaiyan, Todd Villines, Jonathon Leipsic, Leslee Shaw, Sabee Molloi
Journal: Circulation (2024)

INTRODUCTION: Coronary CT angiography (CCTA) is a powerful noninvasive tool for identifying high-risk plaque, such as low-density non-calcified plaque (LD-NCP). Though, the optimal treatment of patients with LD-NCP remains unclear. This study explored the association of revascularization in the setting of LD-NCP with the occurrence of acute coronary syndrome (ACS). Methods: This was a post-hoc analysis of the ICONIC study. A subset of 234 patients that underwent CCTA with subsequent ACS were matched to 234 control patients who also underwent CCTA but did not have ACS during follow-up. Patients were also followed for occurrence of revascularization, either coronary artery bypass graft or percutaneous coronary intervention. Atherosclerosis imaging-enabled quantitative CT (AI-QCT) was used to measure diameter stenosis, and LD-NCP, non-calcified plaque, and calcified plaque volumes from each CCTA. LD-NCP was defined as plaque with -190 to 30 Hounsfield Units. Patients were stratified based on the presence of LD-NCP. Subgroup analysis was conducted to compare the occurrence of ACS with the rate of revascularization. Kaplan-Meier survival curves and extended Cox regression analysis were used to evaluate the effect size of revascularization and LD-NCP on occurrence of ACS. Results: AI-QCT was completed in 448/468 subjects (follow-up time [MEAN±SD] 2.44±2.48 years). The median of LD-NCP was 1.2 mm 3 for patients with &gt;0 mm 3 LD-NCP. There were 85 patients with LD-NCP &gt;1.2 mm 3 and 363 patients with LD-NCP ≤1.2 mm 3 . In patients with LD-NCP &gt;1.2 mm 3 , the rate of revascularization in patients with and without ACS was 3/52 (5.8%) versus 14/33 (42.4%) (p&lt;0.001). In patients with LD-NCP ≤1.2 mm 3 , the rate of revascularization in patients with and without ACS was 36/170 (21.2%) versus 39/193 (20.2%) (p=0.897). In comparison to patients without revascularization and LD-NCP ≤1.2 mm 3 , patients with LD-NCP &gt;1.2 mm 3 and revascularization were less likely to have ACS during follow-up (adjusted HR: 0.20 [0.07, 0.61]; p=0.005). Additionally, patients with LD-NCP &gt;1.2 mm 3 who did not undergo revascularization were more likely to have ACS (adjusted HR: 1.47 [1.03, 2.12]; p=0.036). Hazard ratios were adjusted for diameter stenosis, and non-calcified and calcified plaque volume. Time-dependent coefficients were included for diameter stenosis. Conclusion: Revascularization of patients with LD-NCP &gt;1.2 mm 3 identified on CCTA with AI-QCT was associated with less risk for ACS.