Cardiology AdvisorCCTA Plaque Measures Predict MACE in Symptomatic Outpatients Without Known CAD

In 4,267 symptomatic outpatients without known CAD, total plaque burden and noncalcified plaque burden on CCTA independently predicted MACE beyond traditional risk factors and qualitative imaging findings. Patients with total plaque volume of 87.2 mm³ or greater carried more than double the MACE risk (aHR 2.07; p=0.006) at a median 2.5-year follow-up.

Clinical Considerations

• Two quantitative measures survived full adjustment: total plaque burden (aHR 1.18 per 10%; p=0.006) and noncalcified plaque burden (aHR 1.20 per 10%; p=0.007), outperforming qualitative CCTA findings alone.
• Relatively low thresholds drive risk: a total plaque burden of 35.3% and noncalcified plaque burden of 19.7% were sufficient to independently predict MACE, suggesting risk emerges earlier than conventional imaging interpretation may capture.
• Overall MACE rate was 2.8%, with nonfatal MI accounting for only 0.5%, highlighting that death and unstable angina hospitalizations dominated events in this seemingly stable population.
• Volumetric analysis remains time- and resource-intensive, limiting immediate routine adoption; results also may not generalize to asymptomatic patients or those with prior CAD.

Practice Applications

• Incorporate quantitative plaque burden reporting when CCTA is ordered for symptomatic outpatients, particularly total and noncalcified plaque burden.
• Flag patients meeting threshold values (TPV ≥87.2 mm³; TPB ≥35.3%; NCPB ≥19.7%) for intensified risk factor management and follow-up.
• Avoid relying solely on qualitative CCTA interpretation in intermediate-risk symptomatic patients where quantitative data may reclassify risk.
• Anticipate workflow barriers to volumetric analysis and advocate for institutional resources or AI-assisted quantification tools.

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