Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study

Sang Eun Lee; Ji Min Sung; Daniele Andreini; Mouaz H. Al-Mallah; Matthew J. Budoff; Filippo Cademartiri; Kavitha Chinnaiyan; Jung Hyun Choi; Eun Ju Chun; Edoardo Conte; Ilan Gottlieb; Martin Hadamitzky; Yong Jin Kim; Byoung Kwon Lee; Jonathon A. Leipsic; Erica Maffei; Hugo Marques; Pedro de Araújo Gonçalves; Gianluca Pontone; Sanghoon Shin; Peter H. Stone; Habib Samady; Renu Virmani; Jagat Narula; Daniel S. Berman; Leslee J. Shaw; Jeroen J. Bax; Fay Y. Lin; James K. Min; Hyuk Jae Chang

doi:10.1007/s10554-020-01960-z

Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study

Sang Eun Lee, Ji Min Sung, Daniele Andreini, Mouaz H. Al-Mallah, Matthew J. Budoff, Filippo Cademartiri, Kavitha Chinnaiyan, Jung Hyun Choi, Eun Ju Chun, Edoardo Conte, Ilan Gottlieb, Martin Hadamitzky, Yong Jin Kim, Byoung Kwon Lee, Jonathon A. Leipsic, Erica Maffei, Hugo Marques, Pedro de Araújo Gonçalves, Gianluca Pontone, Sanghoon ShinPeter H. Stone, Habib Samady, Renu Virmani, Jagat Narula, Daniel S. Berman, Leslee J. Shaw, Jeroen J. Bax, Fay Y. Lin, James K. Min, Hyuk Jae Chang

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Abstract

To determine whether the assessment of individual plaques is superior in predicting the progression to obstructive coronary artery disease (CAD) on serial coronary computed tomography angiography (CCTA) than per-patient assessment. From a multinational registry of 2252 patients who underwent serial CCTA at a ≥ 2-year inter-scan interval, patients with only non-obstructive lesions at baseline were enrolled. CCTA was quantitatively analyzed at both the per-patient and per-lesion level. Models predicting the development of an obstructive lesion at follow up using either the per-patient or per-lesion level CCTA measures were constructed and compared. From 1297 patients (mean age 60 ± 9 years, 43% men) enrolled, a total of 3218 non-obstructive lesions were identified at baseline. At follow-up (inter-scan interval: 3.8 ± 1.6 years), 76 lesions (2.4%, 60 patients) became obstructive, defined as > 50% diameter stenosis. The C-statistics of Model 1, adjusted only by clinical risk factors, was 0.684. The addition of per-patient level total plaque volume (PV) and the presence of high-risk plaque (HRP) features to Model 1 improved the C-statistics to 0.825 [95% confidence interval (CI) 0.823–0.827]. When per-lesion level PV and the presence of HRP were added to Model 1, the predictive value of the model improved the C-statistics to 0.895 [95% CI 0.893–0.897]. The model utilizing per-lesion level CCTA measures was superior to the model utilizing per-patient level CCTA measures in predicting the development of an obstructive lesion (p < 0.001). Lesion-level analysis of coronary atherosclerotic plaques with CCTA yielded better predictive power for the development of obstructive CAD than the simple quantification of total coronary atherosclerotic burden at a per-patient level. Clinical Trial Registration: ClinicalTrials.gov

Original language	English
Pages (from-to)	2357-2364
Number of pages	8
Journal	International Journal of Cardiovascular Imaging
Volume	36
Issue number	12
DOIs	https://doi.org/10.1007/s10554-020-01960-z
State	Published - Dec 2020

Keywords

Coronary artery atherosclerosis
Coronary artery disease
Coronary computed tomography angiography
Statins

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Lee, S. E., Sung, J. M., Andreini, D., Al-Mallah, M. H., Budoff, M. J., Cademartiri, F., Chinnaiyan, K., Choi, J. H., Chun, E. J., Conte, E., Gottlieb, I., Hadamitzky, M., Kim, Y. J., Lee, B. K., Leipsic, J. A., Maffei, E., Marques, H., de Araújo Gonçalves, P., Pontone, G., ... Chang, H. J. (2020). Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study. International Journal of Cardiovascular Imaging, 36(12), 2357-2364. https://doi.org/10.1007/s10554-020-01960-z

Lee, Sang Eun ; Sung, Ji Min ; Andreini, Daniele et al. / Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions : the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study. In: International Journal of Cardiovascular Imaging. 2020 ; Vol. 36, No. 12. pp. 2357-2364.

@article{e12d507f166e47bd8a3f7a808ebfbe3c,

title = "Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study",

abstract = "To determine whether the assessment of individual plaques is superior in predicting the progression to obstructive coronary artery disease (CAD) on serial coronary computed tomography angiography (CCTA) than per-patient assessment. From a multinational registry of 2252 patients who underwent serial CCTA at a ≥ 2-year inter-scan interval, patients with only non-obstructive lesions at baseline were enrolled. CCTA was quantitatively analyzed at both the per-patient and per-lesion level. Models predicting the development of an obstructive lesion at follow up using either the per-patient or per-lesion level CCTA measures were constructed and compared. From 1297 patients (mean age 60 ± 9 years, 43% men) enrolled, a total of 3218 non-obstructive lesions were identified at baseline. At follow-up (inter-scan interval: 3.8 ± 1.6 years), 76 lesions (2.4%, 60 patients) became obstructive, defined as > 50% diameter stenosis. The C-statistics of Model 1, adjusted only by clinical risk factors, was 0.684. The addition of per-patient level total plaque volume (PV) and the presence of high-risk plaque (HRP) features to Model 1 improved the C-statistics to 0.825 [95% confidence interval (CI) 0.823–0.827]. When per-lesion level PV and the presence of HRP were added to Model 1, the predictive value of the model improved the C-statistics to 0.895 [95% CI 0.893–0.897]. The model utilizing per-lesion level CCTA measures was superior to the model utilizing per-patient level CCTA measures in predicting the development of an obstructive lesion (p < 0.001). Lesion-level analysis of coronary atherosclerotic plaques with CCTA yielded better predictive power for the development of obstructive CAD than the simple quantification of total coronary atherosclerotic burden at a per-patient level. Clinical Trial Registration: ClinicalTrials.gov",

keywords = "Coronary artery atherosclerosis, Coronary artery disease, Coronary computed tomography angiography, Statins",

author = "Lee, {Sang Eun} and Sung, {Ji Min} and Daniele Andreini and Al-Mallah, {Mouaz H.} and Budoff, {Matthew J.} and Filippo Cademartiri and Kavitha Chinnaiyan and Choi, {Jung Hyun} and Chun, {Eun Ju} and Edoardo Conte and Ilan Gottlieb and Martin Hadamitzky and Kim, {Yong Jin} and Lee, {Byoung Kwon} and Leipsic, {Jonathon A.} and Erica Maffei and Hugo Marques and {de Ara{\'u}jo Gon{\c c}alves}, Pedro and Gianluca Pontone and Sanghoon Shin and Stone, {Peter H.} and Habib Samady and Renu Virmani and Jagat Narula and Berman, {Daniel S.} and Shaw, {Leslee J.} and Bax, {Jeroen J.} and Lin, {Fay Y.} and Min, {James K.} and Chang, {Hyuk Jae}",

note = "Publisher Copyright: {\textcopyright} 2020, Springer Nature B.V.",

year = "2020",

month = dec,

doi = "10.1007/s10554-020-01960-z",

language = "English",

volume = "36",

pages = "2357--2364",

journal = "International Journal of Cardiovascular Imaging",

issn = "1569-5794",

publisher = "Springer Science and Business Media B.V.",

number = "12",

}

Lee, SE, Sung, JM, Andreini, D, Al-Mallah, MH, Budoff, MJ, Cademartiri, F, Chinnaiyan, K, Choi, JH, Chun, EJ, Conte, E, Gottlieb, I, Hadamitzky, M, Kim, YJ, Lee, BK, Leipsic, JA, Maffei, E, Marques, H, de Araújo Gonçalves, P, Pontone, G, Shin, S, Stone, PH, Samady, H, Virmani, R, Narula, J, Berman, DS, Shaw, LJ, Bax, JJ, Lin, FY, Min, JK & Chang, HJ 2020, 'Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study', International Journal of Cardiovascular Imaging, vol. 36, no. 12, pp. 2357-2364. https://doi.org/10.1007/s10554-020-01960-z

Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study. / Lee, Sang Eun; Sung, Ji Min; Andreini, Daniele et al.
In: International Journal of Cardiovascular Imaging, Vol. 36, No. 12, 12.2020, p. 2357-2364.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions

T2 - the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study

AU - Lee, Sang Eun

AU - Sung, Ji Min

AU - Andreini, Daniele

AU - Al-Mallah, Mouaz H.

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 - Leipsic, Jonathon A.

AU - Maffei, Erica

AU - Marques, Hugo

AU - de Araújo Gonçalves, Pedro

AU - Pontone, Gianluca

AU - Shin, Sanghoon

AU - Stone, Peter H.

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

PY - 2020/12

Y1 - 2020/12

N2 - To determine whether the assessment of individual plaques is superior in predicting the progression to obstructive coronary artery disease (CAD) on serial coronary computed tomography angiography (CCTA) than per-patient assessment. From a multinational registry of 2252 patients who underwent serial CCTA at a ≥ 2-year inter-scan interval, patients with only non-obstructive lesions at baseline were enrolled. CCTA was quantitatively analyzed at both the per-patient and per-lesion level. Models predicting the development of an obstructive lesion at follow up using either the per-patient or per-lesion level CCTA measures were constructed and compared. From 1297 patients (mean age 60 ± 9 years, 43% men) enrolled, a total of 3218 non-obstructive lesions were identified at baseline. At follow-up (inter-scan interval: 3.8 ± 1.6 years), 76 lesions (2.4%, 60 patients) became obstructive, defined as > 50% diameter stenosis. The C-statistics of Model 1, adjusted only by clinical risk factors, was 0.684. The addition of per-patient level total plaque volume (PV) and the presence of high-risk plaque (HRP) features to Model 1 improved the C-statistics to 0.825 [95% confidence interval (CI) 0.823–0.827]. When per-lesion level PV and the presence of HRP were added to Model 1, the predictive value of the model improved the C-statistics to 0.895 [95% CI 0.893–0.897]. The model utilizing per-lesion level CCTA measures was superior to the model utilizing per-patient level CCTA measures in predicting the development of an obstructive lesion (p < 0.001). Lesion-level analysis of coronary atherosclerotic plaques with CCTA yielded better predictive power for the development of obstructive CAD than the simple quantification of total coronary atherosclerotic burden at a per-patient level. Clinical Trial Registration: ClinicalTrials.gov

AB - To determine whether the assessment of individual plaques is superior in predicting the progression to obstructive coronary artery disease (CAD) on serial coronary computed tomography angiography (CCTA) than per-patient assessment. From a multinational registry of 2252 patients who underwent serial CCTA at a ≥ 2-year inter-scan interval, patients with only non-obstructive lesions at baseline were enrolled. CCTA was quantitatively analyzed at both the per-patient and per-lesion level. Models predicting the development of an obstructive lesion at follow up using either the per-patient or per-lesion level CCTA measures were constructed and compared. From 1297 patients (mean age 60 ± 9 years, 43% men) enrolled, a total of 3218 non-obstructive lesions were identified at baseline. At follow-up (inter-scan interval: 3.8 ± 1.6 years), 76 lesions (2.4%, 60 patients) became obstructive, defined as > 50% diameter stenosis. The C-statistics of Model 1, adjusted only by clinical risk factors, was 0.684. The addition of per-patient level total plaque volume (PV) and the presence of high-risk plaque (HRP) features to Model 1 improved the C-statistics to 0.825 [95% confidence interval (CI) 0.823–0.827]. When per-lesion level PV and the presence of HRP were added to Model 1, the predictive value of the model improved the C-statistics to 0.895 [95% CI 0.893–0.897]. The model utilizing per-lesion level CCTA measures was superior to the model utilizing per-patient level CCTA measures in predicting the development of an obstructive lesion (p < 0.001). Lesion-level analysis of coronary atherosclerotic plaques with CCTA yielded better predictive power for the development of obstructive CAD than the simple quantification of total coronary atherosclerotic burden at a per-patient level. Clinical Trial Registration: ClinicalTrials.gov

KW - Coronary artery atherosclerosis

KW - Coronary artery disease

KW - Coronary computed tomography angiography

KW - Statins

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U2 - 10.1007/s10554-020-01960-z

DO - 10.1007/s10554-020-01960-z

M3 - Article

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AN - SCOPUS:85089248654

SN - 1569-5794

VL - 36

SP - 2357

EP - 2364

JO - International Journal of Cardiovascular Imaging

JF - International Journal of Cardiovascular Imaging

IS - 12

ER -

Lee SE, Sung JM, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F et al. Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study. International Journal of Cardiovascular Imaging. 2020 Dec;36(12):2357-2364. doi: 10.1007/s10554-020-01960-z

Per-lesion versus per-patient analysis of coronary artery disease in predicting the development of obstructive lesions: the Progression of AtheRosclerotic PlAque DetermIned by Computed TmoGraphic Angiography Imaging (PARADIGM) study

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