Impact of Non-obstructive left main disease on the progression of coronary artery disease: A PARADIGM substudy

Jonathan R. Weir-McCall, Philipp Blanke, Stephanie L. Sellers, Amir A. Ahmadi, Daniele Andreini, 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, Sang Eun Lee, Erica Maffei, Hugo Marques, Gianluca Pontone, Gilbert L. RaffSanghoon Shin, Ji Min Sung, Peter 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, Jonathon A. Leipsic

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: The aim of the study is examine the impact of non-obstructive (<50%stenosis) left main (LM) disease on the natural history of coronary artery disease using serial coronary computed tomography angiography (CTA). Methods: CTAs from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) study, a prospective multinational registry of patients who underwent serial CTA at a ≥2 year interval were analyzed. Those without evidence of CAD on their baseline scan were excluded, as were those with obstructive left main disease. Coronary artery vessels and their branches underwent quantification of: plaque volume and composition; diameter stenosis; presence of high-risk plaque. Results: Of 944 (62 ± 9 years, 60% male) who had evidence of CAD at baseline, 444 (47%) had LM disease. Those with LM disease had a higher baseline plaque volume (194.8 ± 221mm3 versus 72.9 ± 84.3mm3, p < 0.001) and a higher prevalence of high-risk plaque (17.5% versus 13%, p < 0.001) than those without LM disease. On multivariable general linear model, patients with LM disease had greater annual rates of progression of total (26.5 ± 31.4mm3/yr versus 14.9 ± 20.1mm3/yr, p < 0.001) and calcified plaque volume (17 ± 24mm3/yr versus 7 ± 11mm3/yr, p < 0.001), with no difference in fibrous, fibrofatty or necrotic core plaque components. Conclusion: The presence of non-obstructive LM disease is associated with greater rates of plaque progression and a higher prevalence of high-risk plaque throughout the entire coronary artery tree compared to CAD without LM involvement. Our data suggests that non-obstructive LM disease may be a marker for an aggressive phenotype of CAD that may benefit from more intensive treatment strategies.

Original languageEnglish
Pages (from-to)231-237
Number of pages7
JournalJournal of Cardiovascular Computed Tomography
Volume12
Issue number3
DOIs
Publication statusPublished - 2018 May 1

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Disease Progression
Coronary Artery Disease
Coronary Vessels
Pathologic Constriction
Atherosclerotic Plaques
Registries
Linear Models
Angiography
Prospective Studies
Phenotype

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Weir-McCall, J. R., Blanke, P., Sellers, S. L., Ahmadi, A. A., Andreini, D., Budoff, M. J., ... Leipsic, J. A. (2018). Impact of Non-obstructive left main disease on the progression of coronary artery disease: A PARADIGM substudy. Journal of Cardiovascular Computed Tomography, 12(3), 231-237. https://doi.org/10.1016/j.jcct.2018.05.011
Weir-McCall, Jonathan R. ; Blanke, Philipp ; Sellers, Stephanie L. ; Ahmadi, Amir A. ; Andreini, Daniele ; Budoff, Matthew J. ; Cademartiri, Filippo ; Chinnaiyan, Kavitha ; Choi, Jung Hyun ; Chun, Eun Ju ; Conte, Edoardo ; Gottlieb, Ilan ; Hadamitzky, Martin ; Kim, Yong Jin ; Lee, Byoung Kwon ; Lee, Sang Eun ; Maffei, Erica ; Marques, Hugo ; Pontone, Gianluca ; Raff, Gilbert L. ; Shin, Sanghoon ; Sung, Ji Min ; Stone, Peter ; Samady, Habib ; Virmani, Renu ; Narula, Jagat ; Berman, Daniel S. ; Shaw, Leslee J. ; Bax, Jeroen J. ; Lin, Fay Y. ; Min, James K. ; Chang, Hyuk-Jae ; Leipsic, Jonathon A. / Impact of Non-obstructive left main disease on the progression of coronary artery disease : A PARADIGM substudy. In: Journal of Cardiovascular Computed Tomography. 2018 ; Vol. 12, No. 3. pp. 231-237.
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title = "Impact of Non-obstructive left main disease on the progression of coronary artery disease: A PARADIGM substudy",
abstract = "Background: The aim of the study is examine the impact of non-obstructive (<50{\%}stenosis) left main (LM) disease on the natural history of coronary artery disease using serial coronary computed tomography angiography (CTA). Methods: CTAs from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) study, a prospective multinational registry of patients who underwent serial CTA at a ≥2 year interval were analyzed. Those without evidence of CAD on their baseline scan were excluded, as were those with obstructive left main disease. Coronary artery vessels and their branches underwent quantification of: plaque volume and composition; diameter stenosis; presence of high-risk plaque. Results: Of 944 (62 ± 9 years, 60{\%} male) who had evidence of CAD at baseline, 444 (47{\%}) had LM disease. Those with LM disease had a higher baseline plaque volume (194.8 ± 221mm3 versus 72.9 ± 84.3mm3, p < 0.001) and a higher prevalence of high-risk plaque (17.5{\%} versus 13{\%}, p < 0.001) than those without LM disease. On multivariable general linear model, patients with LM disease had greater annual rates of progression of total (26.5 ± 31.4mm3/yr versus 14.9 ± 20.1mm3/yr, p < 0.001) and calcified plaque volume (17 ± 24mm3/yr versus 7 ± 11mm3/yr, p < 0.001), with no difference in fibrous, fibrofatty or necrotic core plaque components. Conclusion: The presence of non-obstructive LM disease is associated with greater rates of plaque progression and a higher prevalence of high-risk plaque throughout the entire coronary artery tree compared to CAD without LM involvement. Our data suggests that non-obstructive LM disease may be a marker for an aggressive phenotype of CAD that may benefit from more intensive treatment strategies.",
author = "Weir-McCall, {Jonathan R.} and Philipp Blanke and Sellers, {Stephanie L.} and Ahmadi, {Amir A.} and Daniele Andreini 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 Lee, {Sang Eun} and Erica Maffei and Hugo Marques and Gianluca Pontone and Raff, {Gilbert L.} and Sanghoon Shin and Sung, {Ji Min} and Peter Stone 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 Hyuk-Jae Chang and Leipsic, {Jonathon A.}",
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Weir-McCall, JR, Blanke, P, Sellers, SL, Ahmadi, AA, Andreini, D, Budoff, MJ, Cademartiri, F, Chinnaiyan, K, Choi, JH, Chun, EJ, Conte, E, Gottlieb, I, Hadamitzky, M, Kim, YJ, Lee, BK, Lee, SE, Maffei, E, Marques, H, Pontone, G, Raff, GL, Shin, S, Sung, JM, Stone, P, Samady, H, Virmani, R, Narula, J, Berman, DS, Shaw, LJ, Bax, JJ, Lin, FY, Min, JK, Chang, H-J & Leipsic, JA 2018, 'Impact of Non-obstructive left main disease on the progression of coronary artery disease: A PARADIGM substudy', Journal of Cardiovascular Computed Tomography, vol. 12, no. 3, pp. 231-237. https://doi.org/10.1016/j.jcct.2018.05.011

Impact of Non-obstructive left main disease on the progression of coronary artery disease : A PARADIGM substudy. / Weir-McCall, Jonathan R.; Blanke, Philipp; Sellers, Stephanie L.; Ahmadi, Amir A.; Andreini, Daniele; Budoff, Matthew J.; Cademartiri, Filippo; Chinnaiyan, Kavitha; Choi, Jung Hyun; Chun, Eun Ju; Conte, Edoardo; Gottlieb, Ilan; Hadamitzky, Martin; Kim, Yong Jin; Lee, Byoung Kwon; Lee, Sang Eun; Maffei, Erica; Marques, Hugo; Pontone, Gianluca; Raff, Gilbert L.; Shin, Sanghoon; Sung, Ji Min; Stone, Peter; Samady, Habib; Virmani, Renu; Narula, Jagat; Berman, Daniel S.; Shaw, Leslee J.; Bax, Jeroen J.; Lin, Fay Y.; Min, James K.; Chang, Hyuk-Jae; Leipsic, Jonathon A.

In: Journal of Cardiovascular Computed Tomography, Vol. 12, No. 3, 01.05.2018, p. 231-237.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of Non-obstructive left main disease on the progression of coronary artery disease

T2 - A PARADIGM substudy

AU - Weir-McCall, Jonathan R.

AU - Blanke, Philipp

AU - Sellers, Stephanie L.

AU - Ahmadi, Amir A.

AU - Andreini, Daniele

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 - Lee, Sang Eun

AU - Maffei, Erica

AU - Marques, Hugo

AU - Pontone, Gianluca

AU - Raff, Gilbert L.

AU - Shin, Sanghoon

AU - Sung, Ji Min

AU - Stone, Peter

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

AU - Leipsic, Jonathon A.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: The aim of the study is examine the impact of non-obstructive (<50%stenosis) left main (LM) disease on the natural history of coronary artery disease using serial coronary computed tomography angiography (CTA). Methods: CTAs from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) study, a prospective multinational registry of patients who underwent serial CTA at a ≥2 year interval were analyzed. Those without evidence of CAD on their baseline scan were excluded, as were those with obstructive left main disease. Coronary artery vessels and their branches underwent quantification of: plaque volume and composition; diameter stenosis; presence of high-risk plaque. Results: Of 944 (62 ± 9 years, 60% male) who had evidence of CAD at baseline, 444 (47%) had LM disease. Those with LM disease had a higher baseline plaque volume (194.8 ± 221mm3 versus 72.9 ± 84.3mm3, p < 0.001) and a higher prevalence of high-risk plaque (17.5% versus 13%, p < 0.001) than those without LM disease. On multivariable general linear model, patients with LM disease had greater annual rates of progression of total (26.5 ± 31.4mm3/yr versus 14.9 ± 20.1mm3/yr, p < 0.001) and calcified plaque volume (17 ± 24mm3/yr versus 7 ± 11mm3/yr, p < 0.001), with no difference in fibrous, fibrofatty or necrotic core plaque components. Conclusion: The presence of non-obstructive LM disease is associated with greater rates of plaque progression and a higher prevalence of high-risk plaque throughout the entire coronary artery tree compared to CAD without LM involvement. Our data suggests that non-obstructive LM disease may be a marker for an aggressive phenotype of CAD that may benefit from more intensive treatment strategies.

AB - Background: The aim of the study is examine the impact of non-obstructive (<50%stenosis) left main (LM) disease on the natural history of coronary artery disease using serial coronary computed tomography angiography (CTA). Methods: CTAs from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) study, a prospective multinational registry of patients who underwent serial CTA at a ≥2 year interval were analyzed. Those without evidence of CAD on their baseline scan were excluded, as were those with obstructive left main disease. Coronary artery vessels and their branches underwent quantification of: plaque volume and composition; diameter stenosis; presence of high-risk plaque. Results: Of 944 (62 ± 9 years, 60% male) who had evidence of CAD at baseline, 444 (47%) had LM disease. Those with LM disease had a higher baseline plaque volume (194.8 ± 221mm3 versus 72.9 ± 84.3mm3, p < 0.001) and a higher prevalence of high-risk plaque (17.5% versus 13%, p < 0.001) than those without LM disease. On multivariable general linear model, patients with LM disease had greater annual rates of progression of total (26.5 ± 31.4mm3/yr versus 14.9 ± 20.1mm3/yr, p < 0.001) and calcified plaque volume (17 ± 24mm3/yr versus 7 ± 11mm3/yr, p < 0.001), with no difference in fibrous, fibrofatty or necrotic core plaque components. Conclusion: The presence of non-obstructive LM disease is associated with greater rates of plaque progression and a higher prevalence of high-risk plaque throughout the entire coronary artery tree compared to CAD without LM involvement. Our data suggests that non-obstructive LM disease may be a marker for an aggressive phenotype of CAD that may benefit from more intensive treatment strategies.

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DO - 10.1016/j.jcct.2018.05.011

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