{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:18:38Z","timestamp":1791883118394,"version":"4.3.4"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2020,5,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The future risk of myocardial infarction is commonly assessed using cardiovascular risk scores, coronary artery calcium score, or coronary artery stenosis severity. We assessed whether noncalcified low-attenuation plaque burden on coronary CT angiography (CCTA) might be a better predictor of the future risk of myocardial infarction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In a post hoc analysis of a multicenter randomized controlled trial of CCTA in patients with stable chest pain, we investigated the association between the future risk of fatal or nonfatal myocardial infarction and low-attenuation plaque burden (% plaque to vessel volume), cardiovascular risk score, coronary artery calcium score or obstructive coronary artery stenoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In 1769 patients (56% male; 58\u00b110 years) followed up for a median 4.7 (interquartile interval, 4.0\u20135.7) years, low-attenuation plaque burden correlated weakly with cardiovascular risk score (\n                      <jats:italic>r<\/jats:italic>\n                      =0.34;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001), strongly with coronary artery calcium score (\n                      <jats:italic>r<\/jats:italic>\n                      =0.62;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001), and very strongly with the severity of luminal coronary stenosis (area stenosis,\n                      <jats:italic>r<\/jats:italic>\n                      =0.83;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Low-attenuation plaque burden (7.5% [4.8\u20139.2] versus 4.1% [0\u20136.8];\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001), coronary artery calcium score (336 [62\u20131064] versus 19 [0\u2013217] Agatston units;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001), and the presence of obstructive coronary artery disease (54% versus 25%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) were all higher in the 41 patients who had fatal or nonfatal myocardial infarction. Low-attenuation plaque burden was the strongest predictor of myocardial infarction (adjusted hazard ratio, 1.60 (95% CI, 1.10\u20132.34) per doubling;\n                      <jats:italic>P<\/jats:italic>\n                      =0.014), irrespective of cardiovascular risk score, coronary artery calcium score, or coronary artery area stenosis. Patients with low-attenuation plaque burden greater than 4% were nearly 5 times more likely to have subsequent myocardial infarction (hazard ratio, 4.65; 95% CI, 2.06\u201310.5;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In patients presenting with stable chest pain, low-attenuation plaque burden is the strongest predictor of fatal or nonfatal myocardial infarction. These findings challenge the current perception of the supremacy of current classical risk predictors for myocardial infarction, including stenosis severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT01149590.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.119.044720","type":"journal-article","created":{"date-parts":[[2020,3,18]],"date-time":"2020-03-18T14:40:33Z","timestamp":1584542433000},"page":"1452-1462","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":738,"title":["Low-Attenuation Noncalcified Plaque on Coronary Computed Tomography Angiography Predicts Myocardial Infarction"],"prefix":"10.1161","volume":"141","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3556-2428","authenticated-orcid":false,"given":"Michelle C.","family":"Williams","sequence":"first","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D\u2019S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."},{"name":"Edinburgh Imaging Facility QMRI (M.C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacek","family":"Kwiecinski","sequence":"additional","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D\u2019S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."},{"name":"Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland (J.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mhairi","family":"Doris","sequence":"additional","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D\u2019S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla","family":"McElhinney","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Medical Centre, Los Angeles, CA (P.M., S.C., P.J.S., D.S.B., D.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle S.","family":"D\u2019Souza","sequence":"additional","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D\u2019S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastien","family":"Cadet","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Medical Centre, Los Angeles, CA (P.M., S.C., P.J.S., D.S.B., D.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip D.","family":"Adamson","sequence":"additional","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D\u2019S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."},{"name":"Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (P.D.A)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair J.","family":"Moss","sequence":"additional","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D\u2019S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirjel","family":"Alam","sequence":"additional","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D\u2019S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Hunter","sequence":"additional","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D\u2019S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anoop S.V.","family":"Shah","sequence":"additional","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D\u2019S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas L.","family":"Mills","sequence":"additional","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D\u2019S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Pawade","sequence":"additional","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D\u2019S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengjia","family":"Wang","sequence":"additional","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D\u2019S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Weir McCall","sequence":"additional","affiliation":[{"name":"University of Cambridge, United Kingdom (J.W.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bonnici-Mallia","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ninewells Hospital, Dundee, United Kingdom (M.B-M., C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Murrills","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ninewells Hospital, Dundee, United Kingdom (M.B-M., C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giles","family":"Roditi","sequence":"additional","affiliation":[{"name":"Institute of Clinical Sciences, University of Glasgow, United Kingdom (G.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin J.R.","family":"van Beek","sequence":"additional","affiliation":[{"name":"University\/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D\u2019S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."},{"name":"Edinburgh Imaging Facility QMRI (M.C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslee J.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Weill Cornell Medical College, New York, NY (L.J.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward D.","family":"Nicol","sequence":"additional","affiliation":[{"name":"Royal Brompton and Harefield NHS Foundation Trust Departments of Cardiology and Radiology; and the National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, United Kingdom (E.D.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S.","family":"Berman","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Medical Centre, Los Angeles, CA (P.M., S.C., P.J.S., D.S.B., 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D.E.N., M.R.D.), University of Edinburgh, United Kingdom."},{"name":"Edinburgh Imaging Facility QMRI (M.C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damini","family":"Dey","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Medical Centre, Los Angeles, CA (P.M., S.C., P.J.S., D.S.B., D.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","article-title":"2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: the Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC).","author":"Knuuti J","year":"2019","unstructured":"Knuuti, J, Wijns, W, Saraste, A, Capodanno, D, Barbato, E, Funck-Brentano, C, Prescott, E, Storey, RF, Deaton, C, Cuisset, T, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: the Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). 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From the Multicenter SCOT-HEART Trial (Scottish Computed Tomography of the HEART)"],"short-title":[],"issued":{"date-parts":[[2020,5,5]]},"references-count":43,"journal-issue":{"issue":"18","published-print":{"date-parts":[[2020,5,5]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.119.044720"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.119.044720","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,5]]},"assertion":[{"value":"2019-11-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-03-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}