Low-Attenuation Noncalcified Plaque on Coronary Computed Tomography Angiography Predicts Myocardial Infarction: Results From the Multicenter SCOT-HEART Trial (Scottish Computed Tomography of the HEART)
Authors' conclusion
In patients presenting with stable chest pain, low-attenuation plaque burden is the strongest predictor of fatal or nonfatal myocardial infarction.
Study context
- Population
- Patients with stable chest pain undergoing coronary CT angiography (56% male; 58±10 years)
- Participants
- 1,769 patients
- Comparison
- MI vs No MI
- MIn = 41
- Primary endpoint
- Fatal or nonfatal MI
- Follow-up
- Median 4.7 (IQR 4.0-5.7) years
Methodological detailspost hoc
- Post hoc
Primary result
As reported in the abstract
median 4.7 years
MI
- Low-attenuation plaque burden
- 7.5% [4.8-9.2]
- CAC score
- 336 [62-1064] Agatston units
- Obstructive CAD
- 54%
No MI
- Low-attenuation plaque burden
- 4.1% [0-6.8]
- CAC score
- 19 [0-217] Agatston units
- Obstructive CAD
- 25%
Low-attenuation plaque burden
MI7.5% [4.8-9.2]
No MI4.1% [0-6.8]
CAC score
MI336 [62-1064] Agatston units
No MI19 [0-217] Agatston units
Obstructive CAD
MI54%
No MI25%
Estimate (95% CI)P value
Low-attenuation plaque burden (per doubling)strongest predictor, irrespective of CV risk score, CAC score or area stenosis
adjusted HR 1.60(1.10–2.34)
P = 0.014Low-attenuation plaque burden >4%
HR 4.65(2.06–10.5)
P < 0.001Per doubling, as printed
Further findings
Correlation of low-attenuation plaque burden with other predictors
- CV risk score (weak), P<0.001
- r=0.34
- CAC score (strong), P<0.001
- r=0.62
- Area stenosis (very strong), P<0.001
- r=0.83
Original publication
Low-Attenuation Noncalcified Plaque on Coronary Computed Tomography Angiography Predicts Myocardial Infarction: Results From the Multicenter SCOT-HEART Trial (Scottish Computed Tomography of the HEART). Circulation. Published 16 March 2020. doi:10.
Summarised from the published abstract; every number is checked against it