Noninvasive Method Could Predict MACE In Patients With Chest Pain

The presence of high-risk plaque found by coronary computed tomographic angiography (CTA) is associated with future major adverse cardiovascular events (MACE) in outpatients with stable chest pain, according to a recent study.

For their study, the researchers assessed the presence of high-risk plaque in 4415 stable, symptomatic patients who were enrolled in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial. Mean patient age was 60.5 years, and 52% of patients were women. Follow-up lasted a median of 25 months.
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All patients included in the study had required noninvasive cardiovascular disease (CVD) testing and received coronary CTA, which was examined for significant stenosis and high-risk plaque

Results indicated that, overall, median atherosclerotic CVD (ASCVD) score was 11, and MACE rate was 3%. High-risk plaques and significant stenosis were found in 676 (15.3%) and 276 (6.3%) patients, respectively. Following adjustment, findings showed that the presence of high-risk plaque was associated with a higher rate of MACE (6.4% vs 2.4%; hazard ratio [HR] 2.73).

The researchers also found that, compared with the absence of high-risk plaque, the presence of high-risk plaque was associated with an increased risk of MACE in patients with nonobstructive coronary artery disease (adjusted HR [aHR] 4.31 vs 2.64). However, they did not observe any significant differences in MACE in patients with significant stenosis and high-risk plaque vs those with significant stenosis but not high-risk plaque (aHR 8.68 vs. 9.31).

Ultimately, the researchers concluded that the presence of high-risk plaque could potentially be useful in regard to risk stratification. High-risk plaque strongly predicted MACE in women vs men (aHR 2.41 vs 1.40) and in younger patients vs older patients (aHR 2.33 vs 1.36).

“High-risk plaque found by coronary CTA was associated with a future MACE in a large US population of outpatients with stable chest pain,” the researchers wrote. “High-risk plaque may be an additional risk stratification tool, especially in patients with nonobstructive coronary artery disease, younger patients, and women. The importance of findings is limited by low absolute MACE rates and low positive predictive value of high-risk plaque.”

—Christina Vogt

Reference:

Ferencik M, Mayrhofer T, Bittner DO, et al. Use of high-risk coronary atherosclerotic plaque detection for risk stratification of patients with stable chest pain: a secondary analysis of the PROMISE randomized clinical trial [Published online January 10, 2018]. JAMA Cardiol. doi:10.1001/jamacardio.2017.4973.