High-risk plaque on coronary CTA linked to future MACE

(HealthDay)—For outpatients with stable chest pain, high-risk plaque found by coronary computed tomographic angiography (CTA) is associated with subsequent major adverse cardiovascular events (MACE), according to a study published online Jan. 10 in JAMA Cardiology.

Maros Ferencik, M.D., Ph.D., from Oregon Health and Science University in Portland, and colleagues conducted a prespecified nested observational cohort study to examine whether high-risk plaque detected by coronary CTA was correlated with incident MACE. All 4,415 stable symptomatic patients who received coronary CTA were followed for a median of 25 months.

Overall, the median atherosclerotic cardiovascular disease (ASCVD) risk score was 11 and the MACE rate was 3 percent. A total of 15.3 percent of patients had high-risk plaques, and 6.3 percent had significant stenosis (SS). The researchers found that the rate of MACE was higher with the presence of high-risk plaque (6.4 versus 2.4 percent; hazard ratio, 2.73). Even after adjustment for ASCVD risk score and SS, the correlation persisted (adjusted hazard ratio, 1.72). There was a continuous net reclassification improvement with the addition of high-risk plaque to the ASCVD risk score and SS assessment (0.34). Among patients with nonobstructive coronary artery disease, the presence of high-risk plaque increased MACE risk relative to patients without high-risk plaque (adjusted hazard ratio, 4.31 versus 2.64).

"High-risk plaque may be an additional risk stratification tool, especially in patients with nonobstructive coronary artery disease, younger patients, and women," the authors write.

Several authors disclosed financial ties to the pharmaceutical and medical device industries.