ObjectivesThis prospective observational cohort study assessed: 1. outcomes in patients with positive or negative remodeling of coronary artery plaque; and 2. the relationship between outcomes and quantitative plaque characteristics.BackgroundComputed tomography (CT) angiography is a noninvasive imaging technique for assessing not only coronary artery stenosis but also plaque characteristics including plaque ‘‘remodeling’’, with plaques that show substantial positive remodeling potentially having a higher risk for cardiovascular events than plaques with lesser extent of remodeling.MethodsBetween September 2005 and February 2010, 7,164 consecutive patients underwent 64-slice coronary CTA. Among these patients, 557 patients who had coronary artery disease (more than 50% diameter stenosis) were enrolled. In these 557 patients, only patients without previous coronary artery revascularization or coronary bypass graft were included, resulting in the exclusion of 369 patients. Based on coronary artery remodeling index, the study population was divided into 2 groups: patients with negative remodeling (77.7%), and patients with positive remodeling (22.3%). The mean duration of follow-up was 291 (228-355) days. Primary outcome was incidence of acute coronary events (composite of cardiac death, unstable angina, or non fatal myocardial infarction); and secondary end point was incidence of coronary artery revascularization and all-cause mortality.ResultsAmong the 188 patients, one cardiac death occurred because of fatal ST segment elevation myocardial infarction (STEMI) in positive remodeling group (PRG), and one with non-ST segment elevation myocardial infarction (NSTEMI) occurred in negative remodeling group (NRG). Nine patients (21.4%) developed unstable angina in PRG and 10 patients (6.9%) developed unstable angina in NRG (p