In patients with stable chest pain undergoing CCTA, the high-risk CAD-RADS 2.0 category was independently associated with MACEs, and plaque burden provided prognostic information beyond age, sex, and significant stenosis, though confirmation in larger prospective and externally validated cohorts is required.
Over a median follow-up of 51.2 months, 41 of 563 patients (7.3%) with stable chest pain undergoing CCTA experienced MACEs.
A substantial share of MACEs occurred in patients with non-obstructive CAD, and most of these had severe or extensive plaque burden.
After adjustment for age and sex, significant stenosis was not associated with MACEs, whereas the high-risk CAD-RADS 2.0 category was independently associated with MACEs.
Adding plaque burden to a model with age, sex, and significant stenosis improved discrimination and model fit.
In the extended model, severe-to-extensive plaque burden remained independently associated with MACEs.
The authors conclude that plaque burden provides prognostic information beyond age, sex, and stenosis, but that confirmation is needed.
This study looked at 563 people with stable chest pain who had a coronary CT scan, and followed them for a median of about four years. It asked whether measuring how much plaque is present in the heart's arteries, in addition to how narrow the arteries are, helps predict future heart events such as heart attacks. In total, 41 patients (7.3%) had a major cardiovascular event. Many of the events occurred in people whose arteries were not significantly narrowed. Of 477 patients with non-obstructive disease, 29 (6.1%) had an event, and about 85% of those had a large amount of plaque. After accounting for age and sex, significant narrowing was not linked to events in this group, but a 'high-risk' category that also counted plaque burden was linked to roughly a threefold higher risk. Adding plaque burden to a model that already included age, sex, and narrowing modestly improved its predictive performance. This research suggests that looking at total plaque burden on CT scans may give additional information about future risk beyond how narrow the arteries are. However, the study was retrospective, drew on a single group of patients, and had few events, so the results are preliminary and need confirmation in larger, prospective studies in other settings.
Ezponda A, Rodríguez J, Sogbe M, Boldó P, Álvarez A, de-Torres J, et al.. (2026). Prognostic Value of Plaque Burden Beyond Stenosis Severity in Patients with Stable Chest Pain Undergoing Coronary CT Angiography.. Medical sciences (Basel, Switzerland). https://doi.org/10.3390/medsci14060648