Outcomes with revascularization vs. medical therapy according to plaque burden from coronary computed tomography angiography
Authors' conclusion
In this cohort study of patients referred for CCTA, revascularization on top of medical therapy was associated with a lower rate of long-term death, MI, or uAP from per-vessel PAV of 22% upwards.
Study context
- Population
- Consecutive patients undergoing coronary computed tomography angiography (CCTA) and selective 15O-water perfusion positron emission tomography for evaluation of coronary artery disease (CAD)subcohort for Cox regression, 206 events, median follow-up 6.8 years
- Participants
- 2,233 patients
- Exposure
- Revascularization vs. medical therapy according to plaque burden (percent atheroma volume (PAV)) from CCTA
- Outcome
- Death, MI, or uAP: interaction between revascularization and continuous PAV
- Follow-up
- Median 6.8 years
Methodological detailsconsecutive patients, two tertiary care centres in Finland and The Netherlands, AI-guided quantitative computed tomography (AI-QCT), Cox regression adjusted for calcium score, ischaemia, cardiovascular risk factors, symptoms, and medication
- Consecutive patients
- Two tertiary care centres in Finland and The Netherlands
- AI-guided quantitative computed tomography (AI-QCT)
- Cox regression adjusted for calcium score, ischaemia, cardiovascular risk factors, symptoms, and medication
Main finding
As reported in the abstract
Patient-level p-interaction
0.042
Vessel-level p-interaction
0.026
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Death, MI, or uAP at PAV 22% or higher · median follow-up 6.8 yearsRevascularizationvs Medical therapyPer-patient PAV 22% | 0.70 (0.43–0.98) | ||
| Death, MI, or uAP at PAV 22% or higher · median follow-up 6.8 yearsRevascularizationvs Medical therapyPer-vessel PAV 22% | 0.64 (0.29–0.99) | ||
| Death, MI, or uAP in PAV ≥22% (subgroup analyses)Revascularizationvs Medical therapyPer-vessel PAV ≥22%; p-interaction = 0.016 | 0.50 (0.27–0.91) | P = 0.024 | |
| Death, MI, or uAP in PAV ≥22% (subgroup analyses)Revascularizationvs Medical therapyPatient-level, non-significant; p-interaction < 0.001 | 0.62 (0.35–1.10) | P = 0.104 | |
| 0.20.5125Hazard ratio (log scale) |
- Death, myocardial infarction (MI), or unstable angina pectoris (uAP) in PAV ≥22% (subgroup analyses): adjusted for age, sex, cardiovascular risk factors, ischaemia, anti-platelet, and lipid-lowering drugs
Original publication
Outcomes with revascularization vs. medical therapy according to plaque burden from coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging. Published 29 December 2025. doi:10.
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