Progression of whole-heart Atherosclerosis by coronary CT and major adverse cardiovascular events

Alexander R. van Rosendael, Fay Y. Lin, Inge J. van den Hoogen, Xiaoyue Ma, Umberto Gianni, Omar Al Hussein Alawamlh, Subhi J. Al'Aref, Jessica M. Peña, Daniele Andreini, Matthew J. Budoff, Filippo Cademartiri, Kavitha Chinnaiyan, Jung Hyun Choi, Edoardo Conte, Hugo Marques, Pedro de Araújo Gonçalves, Ilan Gottlieb, Martin Hadamitzky, Jonathon Leipsic, Erica MaffeiGianluca Pontone, Gilbert L. Raff, Sanghoon Shin, Yong Jin Kim, Byoung Kwon Lee, Eun Ju Chun, Ji Min Sung, Sang Eun Lee, Donghee Han, Daniel S. Berman, Renu Virmani, Habib Samady, Peter Stone, Jagat Narula, Jeroen J. Bax, Leslee J. Shaw, James K. Min, Hyuk Jae Chang

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: The current study aimed to examine the independent prognostic value of whole-heart atherosclerosis progression by serial coronary computed tomography angiography (CCTA) for major adverse cardiovascular events (MACE). Methods: The multi-center PARADIGM study includes patients undergoing serial CCTA for symptomatic reasons, ≥2 years apart. Whole-heart atherosclerosis was characterized on a segmental level, with co-registration of baseline and follow-up CCTA, and summed to per-patient level. The independent prognostic significance of atherosclerosis progression for MACE (non-fatal myocardial infarction [MI], death, unplanned coronary revascularization) was examined. Patients experiencing interval MACE were not omitted. Results: The study population comprised 1166 patients (age 60.5 ​± ​9.5 years, 54.7% male) who experienced 139 MACE events during 8.2 (IQR 6.2, 9.5) years of follow up (15 death, 5 non-fatal MI, 119 unplanned revascularizations). Whole-heart percent atheroma volume (PAV) increased from 2.32% at baseline to 4.04% at follow-up. Adjusted for baseline PAV, the annualized increase in PAV was independently associated with MACE: OR 1.23 (95% CI 1.08, 1.39) per 1 standard deviation increase, which was consistent in multiple subpopulations. When categorized by composition, only non-calcified plaque progression associated independently with MACE, while calcified plaque did not. Restricting to patients without events before follow-up CCTA, those with future MACE showed an annualized increase in PAV of 0.93% (IQR 0.34, 1.96) vs 0.32% (IQR 0.02, 0.90), P ​< ​0.001. Conclusions: Whole-heart atherosclerosis progression examined by serial CCTA is independently associated with MACE, with a prognostic threshold of 1.0% increase in PAV per year.

Original languageEnglish
Pages (from-to)322-330
Number of pages9
JournalJournal of Cardiovascular Computed Tomography
Issue number4
StatePublished - 1 Jul 2021


  • Coronary CTA
  • Coronary artery disease
  • Plaque progression
  • Risk stratification


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