Key result
CT-identified obstructive disease is linked to ~338% greater 10-year MI risk in stable chest pain.
Why the study?
The long-term prognostic ability of CCTA parameters beyond short and medium-term cardiac event prediction was not known.
Do CCTA markers of coronary artery disease predict future myocardial infarction at 10 years in patients presenting with stable chest pain?
Do CCTA markers of coronary artery disease predict future myocardial infarction at 10 years in patients presenting with stable chest pain?
In patients with stable chest pain, CCTA findings including obstructive disease and low attenuation plaque burden provide strong prognostic value for myocardial infarction extending beyond 10 years.
CCTA markers may refine 10-year MI risk assessment in stable chest pain; extends short-term data but leaves open need for prospective validation.
Background Coronary artery stenosis, coronary artery calcium (CAC) score, quantitatively assessed coronary artery plaque burden and pericoronary adipose tissue (PCAT) attenuation density are predictive of cardiac events in the short and medium term. However, the long-term prognostic ability of these coronary CT angiography (CCTA) parameters is not known. Purpose We assessed whether markers of coronary artery disease on CCTA could predict future myocardial infarction at 10 years in the Scottish Computed Tomography of the Heart (SCOT-HEART) trial. Methods This post hoc analysis included patients who underwent CCTA in the SCOT-HEART multicentre randomised control trial. Clinical cardiovascular risk was assessed with the ASSIGN 10-year cardiovascular risk score. Coronary artery calcium was assessed with the Agatston score. The presence of obstructive disease (>70% stenosis) was visually assessed. The burden of calcified, non-calcified, low attenuation, and total plaque and the PCAT attenuation density was assessed with dedicated software (Autoplaque). The occurrence of fatal or non-fatal myocardial infarction at 10 years of follow up was obtained from national healthcare records. Results In 1769 patients, fatal or non-fatal myocardial infarction occurred in 117 patients after 9.7±2.0 years. Patients with myocardial infarction had a higher cardiovascular risk score (22 [interquartile range 15,32] versus 15 [9, 23], p<0.001), higher coronary artery calcium score (387 [59, 1041] versus 15 [0, 190] Agatston units, p<0.001) and more obstructive disease (59% versus 23%, p<0.001). The burden of calcified, non-calcified, low attenuation and total plaque was higher in patients with myocardial infarction (p<0.001 for all). When adjusted for cardiovascular risk score, the total, calcified, non-calcified and low attenuation plaque burden were independent predictors of myocardial infarction in all patients, and in both men and women (Table 1). Pericoronary adipose tissue attenuation was higher in patients with myocardial infarction and was an independent predictor of myocardial infarction over the cardiovascular risk score in men but not in women. The strongest predictors of subsequent myocardial infarction were obstructive disease (Hazard ratio [HR] 4.38, 95% confidence interval [CI] 3.03 to 6.33, p<0.001) and low attenuation plaque burden greater than 4% (HR 3.47, 95% CI 2.24 to 5.36, p<0.001). Conclusions In patients presenting with stable chest pain, CT findings provide important prognostic ability extending beyond 10 years. Table1 Figure1
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Macmillan et al. (2025) studied this question. In stable chest pain patients, obstructive disease (HR 4.38) and low attenuation plaque >4% (HR 3.47) on CT independently predicted 10-year myocardial infarction risk.
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