QUANTITATIVE CORONARY CT plaque measures independently predicted major adverse cardiovascular events in symptomatic patients without known coronary artery disease, improving risk stratification beyond clinical assessment and standard imaging metrics.
Quantitative Coronary CT Plaque Measures and Prognostic Value
In a post hoc analysis of a large prospective randomised clinical trial conducted across 193 sites in North America, investigators evaluated the incremental prognostic value of quantitative coronary artery disease measures derived from coronary computed tomographic angiography in symptomatic outpatients without known coronary artery disease. The trial enrolled participants between July 27, 2010, and October 31, 2014, with data analysed from January 2021 to July 2024.
Core laboratory based quantitative plaque measures included total plaque volume, calcified plaque volume, noncalcified plaque volume, low attenuation plaque volume, total plaque burden, and noncalcified plaque burden, all normalised to vessel volume. The primary outcome was major adverse cardiovascular events, defined as a composite of death, nonfatal myocardial infarction, or hospitalisation for unstable angina. Optimal predictive cut points were determined using Euclidean distance methods and assessed in multivariable Cox regression models.
Association Between Quantitative Coronary CT Plaque Measures And MACE
Among 4267 patients, mean age was 60.4 years and 51.5% were female. The median total plaque volume was 39.8 mm3. Patients with total plaque volume at or above the median were older, more likely to be male, and had higher atherosclerotic cardiovascular disease risk scores. Total plaque burden showed similar demographic associations.
Both total plaque burden and noncalcified plaque burden independently predicted major adverse cardiovascular events after adjustment for clinical risk factors, statin use, and qualitative coronary computed tomographic angiography findings. Data were as follows: total plaque burden adjusted hazard ratio 1.18; 95% CI: 1.05–1.34; P=.006; noncalcified plaque burden adjusted hazard ratio 1.20; 95% CI: 1.05–1.37; P=.007.
Risk Thresholds For Quantitative Coronary CT Plaque Measures
Optimal cut points of total plaque volume 87 mm3 or greater, total plaque burden 35% or greater, and noncalcified plaque burden 20% or greater were each associated with nearly a twofold increase in major adverse cardiovascular events risk. Data were as follows: total plaque volume adjusted hazard ratio 2.07; 95% CI: 1.24–3.49; total plaque burden adjusted hazard ratio 1.96; 95% CI: 1.21–3.17; noncalcified plaque burden adjusted hazard ratio 1.77; 95% CI: 1.12–2.82.
Although overall plaque volumes and burdens were low in this cohort, quantitative coronary CT plaque measures were associated with established cardiovascular risk factors and independently predictive of adverse outcomes. These findings suggest that quantitative coronary computed tomographic angiography may enhance early cardiovascular risk assessment beyond clinical risk scores and routinely assessed imaging features.
Reference
Karády J et al. Prognostic value of plaque volume in patients with first diagnosis of coronary artery disease: a substudy of the PROMISE randomized clinical trial. JAMA Cardiol. 2026;doi: 10.1001/jamacardio.2025.5520.
