Atherosclerosis Evaluation and Cardiovascular Risk Estimation Using Coronary Computed Tomography Angiography

Overview

Journal Eur Heart J

Publisher Oxford University Press

Specialty Cardiology & Vascular Diseases

Date 2024 Apr 12

PMID 38606889

Authors

Nick S Nurmohamed

Alexander R van Rosendael

Ibrahim Danad

Quyen Ngo-Metzger

Pam R Taub

Kausik K Ray

Gemma Figtree

Marc P Bonaca

Judith Hsia

Fatima Rodriguez

Alexander T Sandhu

Koen Nieman

James P Earls

Udo Hoffmann

Jeroen J Bax

James K Min

David J Maron

Deepak L Bhatt

Affiliations

Soon will be listed here.

Abstract

Clinical risk scores based on traditional risk factors of atherosclerosis correlate imprecisely to an individual's complex pathophysiological predisposition to atherosclerosis and provide limited accuracy for predicting major adverse cardiovascular events (MACE). Over the past two decades, computed tomography scanners and techniques for coronary computed tomography angiography (CCTA) analysis have substantially improved, enabling more precise atherosclerotic plaque quantification and characterization. The accuracy of CCTA for quantifying stenosis and atherosclerosis has been validated in numerous multicentre studies and has shown consistent incremental prognostic value for MACE over the clinical risk spectrum in different populations. Serial CCTA studies have advanced our understanding of vascular biology and atherosclerotic disease progression. The direct disease visualization of CCTA has the potential to be used synergistically with indirect markers of risk to significantly improve prevention of MACE, pending large-scale randomized evaluation.

Citing Articles

Relationship between atherogenic index of plasma and length of stay in critically ill patients with atherosclerotic cardiovascular disease: a retrospective cohort study and predictive modeling based on machine learning.

Guo Y, Wang F, Ma S, Mao Z, Zhao S, Sui L Cardiovasc Diabetol. 2025; 24(1):95.

PMID: 40022165 PMC: 11871731. DOI: 10.1186/s12933-025-02654-3.

Inflammation in atherosclerosis: a Big Idea that has underperformed so far.

Williams K Curr Opin Lipidol. 2025; .

PMID: 39846349 PMC: 11888836. DOI: 10.1097/MOL.0000000000000973.

Antithrombotic therapy for a case report of acute myocardial infarction after laparoscopic radical cystectomy.

Wang Z, Yuan H, Chu J, Duan S, Zhang Z, Song C Front Pharmacol. 2025; 15():1477715.

PMID: 39830348 PMC: 11739146. DOI: 10.3389/fphar.2024.1477715.

End-to-end deep-learning model for the detection of coronary artery stenosis on coronary CT images.

Gupta V, Petursson P, Rawshani A, Boren J, Ramunddal T, Bhatt D Open Heart. 2025; 12(1.

PMID: 39800435 PMC: 11751816. DOI: 10.1136/openhrt-2024-002998.

Coronary atherosclerosis in athletes: emerging concepts and preventive strategies.

Claessen G, Eijsvogels T, Albert C, Baggish A, Levine B, Marijon E Eur Heart J. 2025; 46(10):890-903.

PMID: 39791533 PMC: 11887545. DOI: 10.1093/eurheartj/ehae927.

References

Ma T, Zhou B, Hsiai T, Shung K . A Review of Intravascular Ultrasound-based Multimodal Intravascular Imaging: The Synergistic Approach to Characterizing Vulnerable Plaques. Ultrason Imaging. 2015; 38(5):314-31. PMC: 4803636. DOI: 10.1177/0161734615604829. View

Fuchs A, Kuhl J, Sigvardsen P, Afzal S, Knudsen A, Moller M . Subclinical Coronary Atherosclerosis and Risk for Myocardial Infarction in a Danish Cohort : A Prospective Observational Cohort Study. Ann Intern Med. 2023; 176(4):433-442. DOI: 10.7326/M22-3027. View

Lin A, Manral N, McElhinney P, Killekar A, Matsumoto H, Kwiecinski J . Deep learning-enabled coronary CT angiography for plaque and stenosis quantification and cardiac risk prediction: an international multicentre study. Lancet Digit Health. 2022; 4(4):e256-e265. PMC: 9047317. DOI: 10.1016/S2589-7500(22)00022-X. View

CASTELLI W, Anderson K, Wilson P, Levy D . Lipids and risk of coronary heart disease. The Framingham Study. Ann Epidemiol. 1992; 2(1-2):23-8. DOI: 10.1016/1047-2797(92)90033-m. View

van Rosendael A, van den Hoogen I, Gianni U, Ma X, Tantawy S, Bax A . Association of Statin Treatment With Progression of Coronary Atherosclerotic Plaque Composition. JAMA Cardiol. 2021; 6(11):1257-1266. PMC: 8374741. DOI: 10.1001/jamacardio.2021.3055. View

Ray K, Wright R, Kallend D, Koenig W, Leiter L, Raal F . Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol. N Engl J Med. 2020; 382(16):1507-1519. DOI: 10.1056/NEJMoa1912387. View

Nurmohamed N, Bom M, Jukema R, de Groot R, Driessen R, van Diemen P . AI-Guided Quantitative Plaque Staging Predicts Long-Term Cardiovascular Outcomes in Patients at Risk for Atherosclerotic CVD. JACC Cardiovasc Imaging. 2023; 17(3):269-280. DOI: 10.1016/j.jcmg.2023.05.020. View

Nakanishi R, Baskaran L, Gransar H, Budoff M, Achenbach S, Al-Mallah M . Relationship of Hypertension to Coronary Atherosclerosis and Cardiac Events in Patients With Coronary Computed Tomographic Angiography. Hypertension. 2017; 70(2):293-299. PMC: 5518701. DOI: 10.1161/HYPERTENSIONAHA.117.09402. View

Hadamitzky M, Achenbach S, Al-Mallah M, Berman D, Budoff M, Cademartiri F . Optimized prognostic score for coronary computed tomographic angiography: results from the CONFIRM registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry). J Am Coll Cardiol. 2013; 62(5):468-76. DOI: 10.1016/j.jacc.2013.04.064. View

10.

Dimitriu-Leen A, Scholte A, van Rosendael A, van den Hoogen I, Kharagjitsingh A, Wolterbeek R . Value of Coronary Computed Tomography Angiography in Tailoring Aspirin Therapy for Primary Prevention of Atherosclerotic Events in Patients at High Risk With Diabetes Mellitus. Am J Cardiol. 2016; 117(6):887-93. DOI: 10.1016/j.amjcard.2015.12.023. View

11.

Kelly C, Lan N, Phan J, Hng C, Matthews A, Rankin J . Characteristics and Outcomes of Young Patients With ST-Elevation Myocardial Infarction Without Standard Modifiable Risk Factors. Am J Cardiol. 2023; 202:81-89. DOI: 10.1016/j.amjcard.2023.06.045. View

12.

Visseren F, Mach F, Smulders Y, Carballo D, Koskinas K, Back M . 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021; 42(34):3227-3337. DOI: 10.1093/eurheartj/ehab484. View

13.

Knuuti J, Ballo H, Juarez-Orozco L, Saraste A, Kolh P, Rutjes A . The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability. Eur Heart J. 2018; 39(35):3322-3330. DOI: 10.1093/eurheartj/ehy267. View

14.

Falk E, Shah P, Fuster V . Coronary plaque disruption. Circulation. 1995; 92(3):657-71. DOI: 10.1161/01.cir.92.3.657. View

15.

Bittencourt M, Hulten E, Ghoshhajra B, OLeary D, Christman M, Montana P . Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. Circ Cardiovasc Imaging. 2014; 7(2):282-91. DOI: 10.1161/CIRCIMAGING.113.001047. View

16.

Nissen S, Lincoff A, Brennan D, Ray K, Mason D, Kastelein J . Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients. N Engl J Med. 2023; 388(15):1353-1364. DOI: 10.1056/NEJMoa2215024. View

17.

Cury R, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M . CAD-RADS™ 2.0 - 2022 Coronary Artery Disease-Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR), and.... J Cardiovasc Comput Tomogr. 2022; 16(6):536-557. DOI: 10.1016/j.jcct.2022.07.002. View

18.

Sandesara P, Mehta A, ONeal W, Kelli H, Sathiyakumar V, Martin S . Clinical significance of zero coronary artery calcium in individuals with LDL cholesterol ≥190 mg/dL: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis. 2019; 292:224-229. DOI: 10.1016/j.atherosclerosis.2019.09.014. View

19.

DAgostino Sr R, Vasan R, Pencina M, Wolf P, Cobain M, Massaro J . General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008; 117(6):743-53. DOI: 10.1161/CIRCULATIONAHA.107.699579. View

20.

Papadopoulou S, Neefjes L, Schaap M, Li H, Capuano E, van der Giessen A . Detection and quantification of coronary atherosclerotic plaque by 64-slice multidetector CT: a systematic head-to-head comparison with intravascular ultrasound. Atherosclerosis. 2011; 219(1):163-70. DOI: 10.1016/j.atherosclerosis.2011.07.005. View