Refined Prediction of MACE in Subclinical Atherosclerosis

New study finds that noninvasive assessment of CAD with CCTA may help reclassify risk and predict MACE in asymptomatic atherosclerosis.

Source: Guaricci AI, Lorenzoni V, Guglielmo M, et al. Prognostic relevance of subclinical coronary and carotid atherosclerosis in a diabetic and nondiabetic asymptomatic population. Clin Cardiol. 2018;41:769-777.

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Subclinical carotid and coronary atherosclerosis burden may predict future cardiovascular events, but identification is challenging. It has been proposed that combining carotid intima media thickness and carotid plaque assessment may improve the ability to identify subclinical disease. Coronary computed tomography angiography (CCTA) directly and noninvasively assesses coronary artery disease (CAD) but its role is unclear in predicting major adverse cardiac events (MACE) in asymptomatic patients.

Are these noninvasive techniques clinically useful in evaluating asymptomatic individuals? Click through the slideshow above to find out more.

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Prospective Study of MACE and Asymptomatic Atherosclerosis. Study of 517 asymptomatic individuals seen from 2004 to 2010, sought to evaluate the incremental contribution of subclinical carotid and coronary atherosclerosis features to risk for MACE. 

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CAD, Plaque Remodeling Independent Predictors of MACE. Study found that CAD ≥50% was linked to over 5 times increased risk of MACE and percent remodeled plaque independently predicted MACE. Also, the study found that a higher CACS and higher incidence of carotid disease was linked to MACE. 

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Clinical Implications: 

  • In asymptomatic at-risk individuals, adding CAD and plaque positive remodeling predicted MACE better vs models with only 10-year FRS, carotid disease, and CACS. 
  • Coronary artery stenosis and plaque remodeling were the most powerful tools of risk classification. 
  • Results support the idea that CAD data incrementally predicts MACE vs 10-year FRS. 
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Take Home Points:

  • CAD ≥ 50% and percent remodeled plaque were independent predictors of 6-year MACE.
  • Adding CAD or remodeled plaque data to statistical models with 10-year FRS, carotid disease, and CACS improved prediction of MACE. 
  • Noninvasive assessment of CAD with CCTA may help predict MACE in asymptomatic atherosclerosis. 
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