Edinburgh Imaging

07 Jul 22. Featured Paper

Plaque burden and 1-year outcomes in acute chest pain: Results from the multicenter RAPID-CTCA Trial

Link to paper on JACC: Cardiovascular Imaging



Mohammed N. Meah, Evangelos Tzolos, Kang-Ling Wang, Anda Bularga, Marc R. Dweck, Nick Curzen, Attila Kardos, Liza Keating, Robert F. Storey, Nicholas L. Mills, Piotr J. Slomka, Damini Dey, David E. Newby, Alasdair Gray, Michelle C. Williams, Carl Roobottom



Objectives: The purpose of this study was to determine whether plaque burden and characteristics can predict subsequent death or myocardial infarction in patients with acute chest pain.

Background: In patients with stable chest pain, computed tomography (CT) plaque burden is an independent predictor of future coronary events.

Methods: In a post hoc analysis of a multicenter trial of early coronary CT angiography, the authors performed quantitative plaque analysis to assess the association between primary endpoint of 1-year all-cause death or nonfatal myocardial infarction and the GRACE (Global Registry of Acute Coronary Events) score, presence of obstructive coronary artery disease, and plaque burden in 404 patients with suspected acute coronary syndrome.

Results: Following the index event, 25 patients had a primary event that was associated with a higher GRACE score (134 ± 44 vs 113 ± 35; P = 0.012), larger burdens of total (46%; interquartile range [IQR: 43%-50%] vs 36% [IQR: 21%-46%]; P < 0.001), noncalcified (41% [IQR: 37%-%47] vs 33% [IQR: 20%-41%]; P < 0.001), and low-attenuation plaque (4.22% [IQR: 3.3%-5.68%] vs 2.14% [IQR: 0.5%-4.88%]; P < 0.001), but not obstructive coronary artery disease (P = 0.065). Total, noncalcified, and low-attenuation plaque burden were the strongest predictors of future events independent of GRACE score and obstructive coronary artery disease (P ≤ 0.002 for all). Patients with a low-attenuation burden above the median had nearly an 8-fold increased risk of the primary endpoint (HR: 7.80 [95% CI: 2.33-26.0]; P < 0.001), outperforming either a GRACE score of >140 (HR: 3.80 [95% CI :1.45-6.98]; P = 0.004) or obstructive coronary artery disease (HR: 2.07 [95% CI: 0.94-4.53]; P = 0.07).

Conclusions: In patients with suspected acute coronary syndrome, low-attenuation plaque burden is a major predictor of 1-year death or recurrent myocardial infarction. (Rapid Assessment of Potential Ischaemic Heart Disease With CTCA [RAPID-CTCA]; NCT02284191)


  • Acute coronary syndromes
  • Coronary computed tomography angiography
  • Low-attenuation plaque
  • Myocardial infarction
  • Quantitative plaque analysis



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