TY - JOUR
T1 - Impact of Non-obstructive left main disease on the progression of coronary artery disease
T2 - A PARADIGM substudy
AU - Weir-McCall, Jonathan R.
AU - Blanke, Philipp
AU - Sellers, Stephanie L.
AU - Ahmadi, Amir A.
AU - Andreini, Daniele
AU - Budoff, Matthew J.
AU - Cademartiri, Filippo
AU - Chinnaiyan, Kavitha
AU - Choi, Jung Hyun
AU - Chun, Eun Ju
AU - Conte, Edoardo
AU - Gottlieb, Ilan
AU - Hadamitzky, Martin
AU - Kim, Yong Jin
AU - Lee, Byoung Kwon
AU - Lee, Sang Eun
AU - Maffei, Erica
AU - Marques, Hugo
AU - Pontone, Gianluca
AU - Raff, Gilbert L.
AU - Shin, Sanghoon
AU - Sung, Ji Min
AU - Stone, Peter
AU - Samady, Habib
AU - Virmani, Renu
AU - Narula, Jagat
AU - Berman, Daniel S.
AU - Shaw, Leslee J.
AU - Bax, Jeroen J.
AU - Lin, Fay Y.
AU - Min, James K.
AU - Chang, Hyuk Jae
AU - Leipsic, Jonathon A.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Background: The aim of the study is examine the impact of non-obstructive (<50%stenosis) left main (LM) disease on the natural history of coronary artery disease using serial coronary computed tomography angiography (CTA). Methods: CTAs from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) study, a prospective multinational registry of patients who underwent serial CTA at a ≥2 year interval were analyzed. Those without evidence of CAD on their baseline scan were excluded, as were those with obstructive left main disease. Coronary artery vessels and their branches underwent quantification of: plaque volume and composition; diameter stenosis; presence of high-risk plaque. Results: Of 944 (62 ± 9 years, 60% male) who had evidence of CAD at baseline, 444 (47%) had LM disease. Those with LM disease had a higher baseline plaque volume (194.8 ± 221mm3 versus 72.9 ± 84.3mm3, p < 0.001) and a higher prevalence of high-risk plaque (17.5% versus 13%, p < 0.001) than those without LM disease. On multivariable general linear model, patients with LM disease had greater annual rates of progression of total (26.5 ± 31.4mm3/yr versus 14.9 ± 20.1mm3/yr, p < 0.001) and calcified plaque volume (17 ± 24mm3/yr versus 7 ± 11mm3/yr, p < 0.001), with no difference in fibrous, fibrofatty or necrotic core plaque components. Conclusion: The presence of non-obstructive LM disease is associated with greater rates of plaque progression and a higher prevalence of high-risk plaque throughout the entire coronary artery tree compared to CAD without LM involvement. Our data suggests that non-obstructive LM disease may be a marker for an aggressive phenotype of CAD that may benefit from more intensive treatment strategies.
AB - Background: The aim of the study is examine the impact of non-obstructive (<50%stenosis) left main (LM) disease on the natural history of coronary artery disease using serial coronary computed tomography angiography (CTA). Methods: CTAs from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) study, a prospective multinational registry of patients who underwent serial CTA at a ≥2 year interval were analyzed. Those without evidence of CAD on their baseline scan were excluded, as were those with obstructive left main disease. Coronary artery vessels and their branches underwent quantification of: plaque volume and composition; diameter stenosis; presence of high-risk plaque. Results: Of 944 (62 ± 9 years, 60% male) who had evidence of CAD at baseline, 444 (47%) had LM disease. Those with LM disease had a higher baseline plaque volume (194.8 ± 221mm3 versus 72.9 ± 84.3mm3, p < 0.001) and a higher prevalence of high-risk plaque (17.5% versus 13%, p < 0.001) than those without LM disease. On multivariable general linear model, patients with LM disease had greater annual rates of progression of total (26.5 ± 31.4mm3/yr versus 14.9 ± 20.1mm3/yr, p < 0.001) and calcified plaque volume (17 ± 24mm3/yr versus 7 ± 11mm3/yr, p < 0.001), with no difference in fibrous, fibrofatty or necrotic core plaque components. Conclusion: The presence of non-obstructive LM disease is associated with greater rates of plaque progression and a higher prevalence of high-risk plaque throughout the entire coronary artery tree compared to CAD without LM involvement. Our data suggests that non-obstructive LM disease may be a marker for an aggressive phenotype of CAD that may benefit from more intensive treatment strategies.
KW - Coronary computed tomography angiography
KW - Left main coronary artery disease
KW - Natural history
UR - http://www.scopus.com/inward/record.url?scp=85047362041&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85047362041&partnerID=8YFLogxK
U2 - 10.1016/j.jcct.2018.05.011
DO - 10.1016/j.jcct.2018.05.011
M3 - Article
C2 - 29802032
AN - SCOPUS:85047362041
SN - 1934-5925
VL - 12
SP - 231
EP - 237
JO - Journal of Cardiovascular Computed Tomography
JF - Journal of Cardiovascular Computed Tomography
IS - 3
ER -