Differences in Plaque Progression Depending on its Characteristics

The pattern of growth for each plaque differs according to the presence of certain risk factors. Atheroma volume at baseline was the most important predictor of plaque developing into obstructive lesions, as opposed to other characteristics historically considered as “dangerous.”

The aim of this study was to analyze whether the pattern of non-obstructive lesion progression could differ according to certain characteristics.

It is still debatable whether such characteristics simply represent a different phase during the natural history of the disease or if they can anticipate disease progression.

This prospective, multinational registry enrolled consecutive patients with non-obstructive coronary artery lesions (<50%), who underwent serial coronary computed tomography angiography at intervals at least 2 years.

High-risk plaque was defined as lesions with 2 or more of the following features: positive remodeling, calcified nodules, and hypoattenuation. Baseline quantitative angiographic percent obstruction and atheroma volume were compared over time between high-risk and non-high-risk plaque.

Read also: Subintimal Re-Entry in CTO Improves Outcomes.

A total of 3049 non-obstructive lesions were identified in 1297 patients (mean age 60.3 ± 9.3 years); 425 lesions met the high-risk criteria and 2624 did not.

Upon adjusted multivariate analysis, only baseline atheroma volume and obstruction percentage could independently predict plaque progression (p < 0.05 for both). High-risk characteristics were not associated with progression over time.

Conclusion

Each non-obstructive plaque has its own individual morphologic pattern, and only baseline atheroma volume and obstruction percentage could predict their progression over time. High-risk characteristics could not predict progression, even when considered as a composite.

Original title: Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes With CCTA.

Reference: Sang-Eun Lee et al. JACC Cardiovasc Imaging. 2020 Jun;13(6):1409-1417. doi: 10.1016/j.jcmg.2019.09.011.

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.