Prognostic Value of Plaque Volume in Patients With First Diagnosis of Coronary Artery Disease

Despite the increasing use of coronary computed tomographic angiography (CCTA) in patients with known or suspected coronary artery disease (CAD), comparatively little is known about its predictive value for adverse events or clinical applicability of volumetric plaque analysis.

To assess the incremental prognostic value of quantitative CAD measures in symptomatic outpatients without known CAD. Design, Setting, and Participants: This post hoc analysis involved a prospective randomized clinical trial conducted across 193 clinical sites in North America. Participants were symptomatic outpatients without known CAD who were randomized to receive CCTA. The trial was conducted from July 27, 2010, to October 31, 2014, and the data analyzed for this report from January 2021 to July 2024. Exposures: Core laboratory-based quantitative plaque measures, including total plaque volume (TPV), calcified (CPV) and noncalcified (NCPV) plaque volume, low-attenuation plaque volume (LAPV), total plaque burden (TPB), and noncalcified plaque burden (NCPB), normalized with vessel volume. Main Outcomes and Measures: The primary outcome was major adverse cardiovascular events MACE (composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina). Optimal predictive cut points for plaque measures were identified using Euclidean distance methods and tested in multivariable Cox regression models.