ArticleEuropean heart journal. Cardiovascular Imaging2020
Non-obstructive high-risk plaques increase the risk of future culprit lesions comparable to obstructive plaques without high-risk features: the ICONIC study.
Article in European heart journal. Cardiovascular Imaging, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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Who cites it
28 citing papers in PubMed.
- Non-calcified plaque volume assessed by coronary computed tomographic angiography: prognostic significance, reproducibility, and temporal progression.European heart journal. Imaging methods and practice · 2026Article
- Association of Low-Attenuation Noncalcified Plaque Shape and Degree of Intraplaque Embeddedness Using Atherosclerotic Imaging-enabled Quantitative CT with Acute Coronary Syndrome.Radiology. Cardiothoracic imaging · 2026Article
- Incremental prognostic value of CCTA-based myocardial radiomics over clinical factors, anatomic and hemodynamic CTA findings in patients with stable angina.The international journal of cardiovascular imaging · 2026Review
- Value of coronary computed tomography angiography-derived plaque multiparameter analysis for guiding the management of intermediate coronary stenosis.Journal of thoracic disease · 2026Article
- Innovations In Artificial Intelligence-Guided Atherosclerosis Cardiovascular Imaging: From Detection to Prognosis.Current atherosclerosis reports · 2026Review
- Semi-Automated Plaque Assessment in Cardiac CT: Prognostic Value in Long-Term Follow-Up of Intermediate Stenosis.Diagnostics (Basel, Switzerland) · 2026Article
- Incremental prognostic value of pericoronary fat attenuation index in diabetic patients with non-obstructive coronary artery disease.BMC medical imaging · 2026Article
- Pericoronary Adipose Tissue Attenuation in Patients with Future Acute Coronary Syndromes: The ICONIC Study.Radiology. Cardiothoracic imaging · 2025Observational
- Whys and Wherefores of Coronary Arterial Positive Remodeling.Arteriosclerosis, thrombosis, and vascular biology · 2024Review
- Assessment of atherosclerotic plaque burden: comparison of AI-QCT versus SIS, CAC, visual and CAD-RADS stenosis categories.The international journal of cardiovascular imaging · 2024Article
- Utility of Artificial Intelligence Plaque Quantification: Results of the DECODE Study.Journal of the Society for Cardiovascular Angiography & Interventions · 2024Article
- Risk factors for instent restenosis of sirolimus-coated stents in coronary intervention for patients with unstable angina.Scientific reports · 2024Article
- Applied coronary physiology for planning and guidance of percutaneous coronary interventions. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2023Article
- Intraplaque Myeloperoxidase Activity as Biomarker of Unstable Atheroma and Adverse Clinical Outcomes in Human Atherosclerosis.JACC. Advances · 2023Article
- Does Coronary Plaque Morphology Matter Beyond Plaque Burden?Current atherosclerosis reports · 2023Review
- Coronary Computed Tomography vs. Cardiac Magnetic Resonance Imaging in the Evaluation of Coronary Artery Disease.Diagnostics (Basel, Switzerland) · 2022Review
- The Atherosclerosis Profile by Coronary Computed Tomography Angiography (CTA) in Symptomatic Patients with Coronary Artery Calcium Score Zero.Diagnostics (Basel, Switzerland) · 2022Article
- Cardiac Computed Tomography: State of the Art and Future Horizons.Journal of clinical medicine · 2022Article
- The Atherosclerotic Profile of a Young Symptomatic Population between 19 and 49 Years: Coronary Computed Tomography Angiography or Coronary Artery Calcium Score?Journal of cardiovascular development and disease · 2021Article
- Impact of atherosclerotic extent on clinical outcome for diabetic patients with non-obstructive coronary artery disease.Atherosclerosis plus · 2021Article
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38 authors.
Funding
Abstract
aimsHigh-risk plaque (HRP) and non-obstructive coronary artery disease independently predict adverse events, but their importance to future culprit lesions has not been resolved. We sought to determine in patients prior to confirmed acute coronary syndrome (ACS) the association between lesion percent diameter stenosis (%DS), and the absolute number and prevalence of HRP. The secondary objective was to examine the relative importance of non-obstructive HRP in future culprit lesions. METHODS AND
resultsWithin the ICONIC study, a nested case-control study of patients undergoing coronary computed tomographic angiography (coronary CT), we included ACS cases with culprit lesions confirmed by invasive coronary angiography and coregistered to baseline coronary CT. Quantitative CT was used to evaluate obstructive (≥50%) and non-obstructive (<50%) diameter stenosis, with HRP defined as ≥2 features of spotty calcification, positive remodelling, or low-attenuation plaque at baseline. A total of 234 patients with downstream ACS over 54 (interquartile range 5-525.5) days exhibited 198/898 plaques with HRP on coronary CT. While HRP was less prevalent in non-obstructive (19.7%, 161/819) than obstructive lesions (46.8%, 37/79, P < 0.001), non-obstructive plaque comprised 81.3% (161/198) of HRP lesions overall. Among the 128 patients with identifiable culprit lesion precursors, the adjusted hazard ratio (HR) was 1.85 [95% confidence interval (CI) 1.26-2.72] for HRP, with no interaction between %DS and HRP (P = 0.82). Compared to non-obstructive HRP lesions, obstructive lesions without HRP exhibited a non-significant HR of 1.41 (95% CI 0.61-3.25, P = 0.42).
conclusionsWhile HRP is more prevalent among obstructive lesions, non-obstructive HRP lesions outnumber those that are obstructive and confer risk clinically approaching that of obstructive lesions without HRP.
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