Abstract 9596: Presence and Extent of Aortic Arch Plaques for the Prediction of Cardiovascular Outcomes in Patients with Suspected Coronary Artery Disease Undergoing Wide Volume Scanning Coronary Computed Tomography Angiography

Abstract

Introduction: Wide volume scanning with 320-row multidetector CT coronary angiography (WVS-CCTA) enables comprehensive assessment of aortic arch together with coronary artery disease (CAD), without additional contrast media injection (Figure A-E). This study investigated prognostic implication of the presence and extent of aortic arch plaques (AAPs) and coronary high-risk plaque burden, as assessed by low-attenuation plaque (LAP) volume, on major cardiovascular events (MACE). Methods: This study consisted of patients with suspected CAD undergoing WVS-CCTA (n=529, mean age 64 yo, 57% of male). Conventional CCTA analysis included the assessment of coronary artery calcium score (CACS), obstructive CAD (diameter stenosis <50%), and %LAP volume (<30 HU). AAP score was defined as the sum of AAP thickness (0: no plaque, 1: <3 mm, 2: 3-5 mm, 3: > 5 mm) and AAP maximum angle (0: no plaque, 1: <120°, 2: 120-240°, 3: > 240°), resulting in a total of 0-6 point(s). The primary endpoint was a MACE composed of all-cause mortality, coronary revascularization, heart failure hospitalization, stroke, and vascular disease requiring invasive treatment. Results: The mean AAP score was 2.0 points (> 2 points in 56% and > 4 points in 27%), which is well correlated with CAD extent and severity. During a follow-up period of 2 years, MACE was observed in 15% of the study patients. In Cox hazard model analysis adjusted by age, gender, chronic kidney disease, and left ventricular ejection fraction <50%, the independent factors associated with MACE were diabetes mellitus [hazard ratio (HR), 1.9; p=0.009], obstructive CAD (HR, 3.8; p <0.001), the 4 th quartile of %LAP volume (HR, 1.8; p=0.016), and AAP score per 1 point increase (HR, 1.2; p=0.008). Conclusion: This study demonstrates unique opportunity for comprehensive evaluation of the presence and extent of AAPs together with CAD, providing prognostic implication of AAP score on MACE in patients with suspected CAD.