Plaque Burden Outlasts Ischemia as Long-Term Predictor of Heart Risk

A large study in the European Journal of Nuclear Medicine and Molecular Imaging suggests plaque burden may be the steadier long-term predictor of heart risk, while ischemia performs better for earlier events. Researchers followed 1,385 patients for a median of 7.1 years, comparing coronary atherosclerotic plaque volume measured with AI-enhanced CT against ischemia measured with PET myocardial perfusion imaging using oxygen-15 labeled water. Across three, six and nine years, total plaque burden remained an independent predictor of death, heart attack and unstable angina. Ischemia predicted early and mid-term events, but its ability to forecast outcomes weakened over longer follow-up. All patients underwent both CCTA and PET, and plaque volume was quantified as percent atheroma volume (PAV) using AI software, while perfusion used hyperemic myocardial blood flow with intravenous adenosine.