CCTA-Derived coronary plaque burden offers enhanced prognostic value over CAC scoring in suspected CAD patients
Journal
European Heart Journal - Cardiovascular Imaging
ISSN
2047-2404
Date Issued
2025-03-25
Author(s)
Ruurt A Jukema
Teemu Maaniitty
Nick S Nurmohamed
Pieter G Raijmakers
Roel Hoek
Roel S Driessen
Jos W R Twisk
Sarah Bär
R Nils Planken
Niels van Royen
Robin Nijveldt
Jeroen J Bax
Antti Saraste
Alexander R van Rosendael
Paul Knaapen
Juhani Knuuti
Ibrahim Danad
Type
journal-article
Abstract
Aims To assess the prognostic utility of coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA)-derived quantitative plaque metrics for predicting adverse cardiovascular outcomes. Methods and results The study enrolled 2404 patients with suspected coronary artery disease (CAD) but without a prior history of CAD. All participants underwent CAC scoring and CCTA, with plaque metrics quantified using an artificial intelligence (AI)-based tool (Cleerly, Inc). Percent atheroma volume (PAV) and non-calcified plaque volume percentage (NCPV%), reflecting total plaque burden and the proportion of non-calcified plaque volume normalized to vessel volume, were evaluated. The primary endpoint was a composite of all-cause mortality and non-fatal myocardial infarction (MI). Cox proportional hazard models, adjusted for clinical risk factors and early revascularization, were employed for analysis. During a median follow-up of 7.0 years, 208 patients (8.7%) experienced the primary endpoint, including 73 cases of MI (3%). The model incorporating PAV demonstrated superior discriminatory power for the composite endpoint (AUC = 0.729) compared to CAC scoring (AUC = 0.706, P = 0.016). In MI prediction, PAV (AUC = 0.791) significantly outperformed CAC (AUC = 0.699, P < 0.001), with NCPV% showing the highest prognostic accuracy (AUC = 0.814, P < 0.001). Conclusion AI-driven assessment of coronary plaque burden enhances prognostic accuracy for future adverse cardiovascular events, highlighting the critical role of comprehensive plaque characterization in refining risk stratification strategies
Cite this document
Dahdal, J., Jukema, R. A., Maaniitty, T., Nurmohamed, N. S., Raijmakers, P. G., Hoek, R., Driessen, R. S., Twisk, J. W. R., Bär, S., Planken, R. N., Van Royen, N., Nijveldt, R., Bax, J. J., Saraste, A., Van Rosendael, A. R., Knaapen, P., Knuuti, J., & Danad, I. (2025). CCTA-Derived coronary plaque burden offers enhanced prognostic value over CAC scoring in suspected CAD patients. European Heart Journal - Cardiovascular Imaging, 26(6), 945-954. https://doi.org/10.1093/ehjci/jeaf093