Williams MC, et al. - In this SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) post hoc analysis, researchers analyzed coronary computed tomography angiography results of 1,769 patients who were followed-up for 5 years to determine the prognostic value of adverse coronary plaque characteristics in patients suspected of having coronary artery disease. The mean age of study participants was 58 ± 10 years; 56% were male. At least one adverse plaque feature was seen among 608 (34%) patients. In patients with an adverse plaque, coronary heart disease death or nonfatal myocardial infarction was observed 3 times more frequently, and twice as frequently vs those with obstructive disease. Compared to patients with normal coronary arteries, the highest event rate, with a 10-fold increase in coronary heart disease death or nonfatal myocardial infarction, was observed in patients with both obstructive disease and adverse plaque; these links were not independent of coronary artery calcium score (a surrogate measure of coronary plaque burden).