Abstract 17494: The Incremental Risk Prediction of Cardiac CTA-Derived Quantitative Atherosclerosis in the International Advance Registry

Abstract

Background: We sought to assess the incremental prognostic utility of AI-enabled quantitative coronary plaque assessment (AI-QCPA) beyond stenosis severity and FFR CT , for the prediction of late revascularization and MACE in the large prospective international ADVANCE registry. Methods: 4737 participants were submitted for AI-QCPA evaluation. Total plaque volume (TPV), calcified plaque volume (CPV), non-calcified plaque volume (NCPV), and low attenuated plaque volume (LAPV) were quantified. In addition, total percent plaque volume (TPAV) and its components were calculated (PV/Vessel Volume * 100). Demographics, stenosis severity, lowest FFR CT , and Delta FFR CT were also recorded. To explore the relationship between plaque measures and MACE (death, myocardial infarction, and unplanned hospitalization leading to revascularization) and late revascularization (>90 days) we performed Kaplan Meier event free outcomes analyses following adjustments for stenosis severity, FFR CT and Delta FFR CT . Results: AI-QCPA was available in 4430 subjects. Mean (SD) TPV was 542.4 ± 522.5 mm 3 . Optimal cutpoints of plaque metrics were predictive of MACE and/or late revascularization when adjusted-TPV (HR- 1.45 CI- 1.06-1.98; P=0.02); CPV (HR- 1.65 CI- 1.21- 2.26; p=0.002); NCPV (HR 1.43 CI- 1.02-1.99; P=0.04) and LAPV (HR- 2.23 CI 1.62-3.07; P=0.03 . Stronger risk prediction was achieved by plaque measures adjusted for vessel volume: TPAV (HR 1.92 CI 1.40- 2.64 P<0.001). This incremental risk discrimination of quantitative plaque measures remained significant as a predictor of MACE alone- TPV- (HR 1.84 CI 1.02- 3.29 P=0.04) TPAV (HR 3.33 CI- 1.85- 6.02 P<0.0001) (Figure 1). Conclusions: In this large prospective international registry, AI-QCPA provided incremental risk discrimination for MACE and late revascularization beyond stenosis severity and FFR CT .