Plaque quantification from coronary computed tomography angiography in predicting cardiovascular events: A systematic review and meta-analysis.

Background: Plaque volumes quantified from coronary computed tomography angiography (CCTA) may offer improved risk prediction for future major adverse cardiovascular events (MACE) above current standards of care. This systematic review and meta-analysis examines the association between CCTA-derived plaque volumes and future MACE in stable coronary artery disease (CAD).

Methods: A systematic literature search was undertaken using PubMed, Web of Science and Cochrane Library databases. 504 publications were screened, identifying 38 studies for inclusion in the systematic review. 15 studies were eligible for meta-analysis. Separate meta-analyses were conducted for the most frequently investigated plaque volume variables.

Results: 35 out of 38 included studies showed an association between quantified plaque volumes and MACE. Low attenuation plaque (LAP) volume and total plaque volume (TPV) were most frequently independently associated with MACE. On meta-analysis, there was a significant association between MACE and TPV (pooled HR 3.93, 95 ​% CI 2.10-7.34, p ​< ​0.0001), LAP volume (pooled HR 2.81, 95 ​% CI 2.01-3.93, p ​< ​0.0001), calcified plaque volume (pooled HR 2.21, 95 ​% 1.5-3.24, p ​< ​0.0001), non-calcified plaque volume (pooled HR 2.55, 95 ​% CI 1.30-4.98, p ​= ​0.006), LAP burden (pooled HR 3.22, 95 ​% CI 2.12-4.87, p ​< ​0.0001), calcified plaque burden (pooled HR 2.25, 95 ​% 1.56-3.24, p ​< ​0.0001) and non-calcified plaque burden (pooled HR 3.42, 95 ​% CI 1.49-7.81, p ​= ​0.004). Total plaque burden was significantly associated with MACE after exclusion of a small study driving considerable heterogeneity (pooled HR 3.81, 95 ​% CI 2.45-5.94, p ​< ​0.0001).

Conclusions: Quantified plaque volumes are associated with MACE in patients undergoing CCTA for stable CAD. Future work is required in diverse populations with standardised methods to determine the clinical utility of plaque quantification in real world practice.