Although coronary CT angiography (CCTA) is increasingly used in patients with suspected or established coronary artery disease (CAD), the prognostic value of volumetric plaque analysis remains less well defined. To address this, investigators from the PROMISE Randomized Clinical Trial evaluated whether quantitative plaque measurements predict major adverse cardiovascular events (MACE) in 4,267 symptomatic patients with no prior diagnosis of CAD. After adjustment for clinical risk factors, statin use, and qualitative CCTA findings, both total plaque burden (TPB; adjusted HR [aHR] 1.18) and noncalcified plaque burden (NCPB; aHR 1.20) independently predicted MACE.
Threshold analyses showed that total plaque volume ≥87 mm³ (aHR 2.07), TPB ≥35% (aHR 1.96), and NCPB ≥20% (aHR, 1.77) were each associated with nearly a two-fold higher risk of events. Together, these results suggest that…
