Coronary CTA Atherosclerosis – Prediction of Prognosis

Just the Presence of Plaque – Clinical Implications

Gabija Pundziute
Interventional cardiologist at University Medical Center Groningen
Groningen
  • Pundziute  et al JACC 2007 first paper to link the presence of atherosclerosis found on CTA as a predictor of prognosis
  • Normal CTA of the Coronary Arteries
    Reconstruction of the coronary arteries shows normal left main LAD, circumflex and RCA
    Ashley Davidoff thecommonvein.net
    44131.5
    • rate of MACE in patients with normal coronary arteries on coronary CTA was 0%.
    • Pundziute  et al found that within one year
      • rate of revascularization was 30% and the
      • rate of hard cardiovascular events was 5%
        This was the first report suggesting that atherosclerotic burden in the coronary arteries may influence patient prognosis beyond stenosis severity.

      • Calcified and Non-Calcified Plaque
        Reconstruction of the coronary arteries shows predominantly non calcified plaque resulting in an elongated stenosis of the proximal LAD (maroon arrows) and short segment stenoses of the proximal RCA (red arrow) circumflex (blue arrow) and diagonal (white arrow) Scattered calcifications are lees prominent in the RCA and circumflex lesions
        Ashley Davidoff thecommonvein.net
        44047b

Lack of Plaque  – Good prognosis

James K. Min
US professor of radiology expert in cardiovascular imaging
  • Min JK et al 2007
    • followed 1,127 low to intermediate risk patients for 15 months
      • without evident coronary artery disease by
        coronary CTA

      • Normal CTA of the Coronary Arteries
        Reconstruction of the coronary arteries shows normal left main LAD, circumflex and RCA
        Ashley Davidoff thecommonvein.net
        44131.5
      • only one death in 333 patients (0.24% per year or 2.4% 10-year risk).

    • Atherosclerotic Plaque With and Without Stenosis

Martin Hadamitzky
Professor in Medicine, German Heart Center Munich
Verified email at dhm.mhn.de
  • Hadamitzky M,et al 2009
  •  1,256 patients with coronary CTA and assessed outcomes at a median follow-up of 18 months.
      • 802 patients without obstructive coronary artery disease,
        • 1 severe cardiac event (0.1%),
      • 348 patients with obstructive coronary artery
        disease

        •  5 severe events
          • – statistically significant difference.
      • Also 802 patients without obstructive coronary artery disease
        • rate of all cardiac events in patients
        • significantly lower than predicted by the Framingham risk score.
Danielle Andreini MD Director of Cardiovascular CT Unit, Deputy Director of the CV MRI Assistant Professor of of CV disease Department of Clinical Sciences and Community Health CV Section University of Milan
    • Andreini D, et al in 2012
    • 1,234 patients
      • followed for a mean of 52 months
      • after coronary CTA,
    • classified according to the presence of
      • normal coronaries
      • nonobstructive (<50%) and
      • obstructive (>50%) coronary lesions
    • 475 events were recorded,
        • 136 hard events (18 cardiac deaths and
        • 118 nonfatal myocardial infarctions
        • 123 late revascularizations.
        • results
          • hard events and all events
            • normal coronaries
              • event-free survival
                • 100%
        • nonobstructive (<50%)
              • event-free survival
                • 88%
        • obstructive (>50%) coronary lesions
              • event-free survival
                • 31%
        • multivessel and left main coronary artery disease
        • associated with higher rates of hard cardiac events.
        • 426 diabetic patients
          • normal coronary arteries on coronary CTA
            • 100% event-free survival.

Links and References

  1. Pundziute G, et al  Prognostic value of multislice computed tomography coronary angiography in patients with
    known or suspected coronary artery disease. JACC 2007; 49: 62-70.
  2. Min JK et al .Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. JACC 2007; 50: 1161-117.
  3. Hadamitzky M,et al . Prognostic value of coronary computed tomographic angiography for prediction of cardiac events in patients with suspected coronary artery disease. JACC Cardiovasc Imaging 2009;2:404-11.
  4. Andreini D, et al  A long-term prognostic value of coronary CT angiography in suspected coronary artery disease.
    JACC Cardiovasc Imaging. 2012 Jul;5(7):690-701.

TCV Map of the Coronary Arteries

Cases