Coronary Plaque Characteristics Associated With Major Adverse Cardiovascular Events in Atherosclerotic Patients and Lesions: A Systematic Review and Meta-Analysis

Guglielmo Gallone, Matteo Bellettini, Marco Gatti, Davide Tore, Francesco Bruno, Luca Scudeler, Vincenzo Cusenza, Antonio Lanfranchi, Andrea Angelini, Ovidio de Filippo, Mario Iannaccone, Luca Baldetti, Katia Audisio, Michelle Demetres, Gaetano Risi, Giulia Rizzello, Italo Porto, Paolo Fonio, Francesco Prati, Michelle C. WilliamsBon Kwon Koo, Gianluca Pontone, Alessandro Depaoli, Peter Libby, Gregg W. Stone, Jagat Narula, Gaetano Maria de Ferrari, Fabrizio d'Ascenzo

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background: The clinical value of high-risk coronary plaque characteristics (CPCs) to inform intensified medical therapy or revascularization of non–flow-limiting lesions remains uncertain. Objectives: The authors performed a systematic review and meta-analysis to study the prognostic impact of CPCs on patient-level and lesion-level major cardiovascular adverse events (MACE). Methods: Thirty studies (21 retrospective, 9 prospective) with 30,369 patients evaluating the association of CPCs with MACE were included. CPCs included high plaque burden, low minimal lumen area, thin cap fibroatheroma, high lipid core burden index, low-attenuation plaque, spotty calcification, napkin ring sign, and positive remodeling. Results: CPCs were evaluated with the use of intracoronary modalities in 9 studies (optical coherence tomography in 4 studies, intravascular ultrasound imaging in 3 studies, and near-infrared spectroscopy intravascular ultrasound imaging in 2 studies) and by means of coronary computed tomographic angiography in 21 studies. CPCs significantly predicted patient-level and lesion-level MACE in both unadjusted and adjusted analyses. For most CPCs, accuracy for MACE was modest to good at the patient level and moderate to good at the lesion level. Plaques with more than 1 CPC had the highest accuracy for lesion-level MACE (AUC: 0.87). Because the prevalence of CPCs among plaques was low, estimated positive predictive values for lesion-level MACE were modest. Results were mostly consistent across imaging modalities and clinical presentations, and in studies with prevailing hard outcomes.

Original languageEnglish
Pages (from-to)1584-1604
Number of pages21
JournalJACC: Cardiovascular Imaging
Issue number12
StatePublished - Dec 2023


  • atherosclerosis
  • coronary computed tomographic angiography
  • high-risk plaque
  • intravascular ultrasound
  • optical coherence tomography
  • vulnerable plaque


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