The composition and extent of coronary artery plaque detected by multislice computed tomographic angiography provides incremental prognostic value in patients with suspected coronary artery disease

Multislice computed tomographic coronary angiography (CTCA) provides accurate noninvasive assessment of coronary artery disease (CAD). However, data on the prognostic value of CTCA in patients with suspected CAD are only beginning to emerge. The aim of the study was to assess the prognostic value of CTCA in patients with suspected CAD. Patients (males = 259, females = 235; mean age 58.2 ± 9.8 years) with suspected CAD who underwent 16- or 64-slice CTCA were followed for 1,308 ± 318 days for cardiac death, nonfatal myocaridal infarction (MI) and late (>90 days after CTCA) revascularization. Patient outcomes were related to clinical and CTCA data. Cox proportional-hazards model was applied in stepwise forward fashion to identify outcome predictors. Coronary artery plaque was found in 340 patients. Cardiac events occurred in 40 patients including cardiac death (n = 9), nonfatal MI (n = 8) and late revascularization (n = 23). A multivariable analysis identified the following independent predictors for adverse cardiac events: obstructive plaque in a proximal coronary artery segment (hazard ratio (HR) 2.73; 95% confidence interval (CI): 1.35–5.54; P = 0.005), the number of segments with noncalcified plaque(s) (HR 1.53 per segment; 95%CI: 1.21–1.92; P < 0.001), the number of segments with mixed plaque(s) (HR 1.56 per segment; 95%CI: 1.27–1.92; P < 0.001) and the number of segments with calcified plaque(s) (HR 1.21 per segment; 95%CI: 1.07–1.37; P = 0.002). In patients with suspected CAD, both the extent and composition of atherosclerotic plaque as determined by CTCA are prognostic of subsequent cardiac events.