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Filippo Cademartiri: Plaque Burden Is the Dominant Determinant of Long-Term Coronary Risk Beyond Stenosis
Filippo Cademartiri/LinkedIn
Apr 15, 2026, 15:59

Filippo Cademartiri: Plaque Burden Is the Dominant Determinant of Long-Term Coronary Risk Beyond Stenosis

Filippo Cademartiri, Consultant Advanced Cardiovascular Imaging at UPMC Salvator Mundi International Hospital, shared on LinkedIn about a recent article by Ruurt A. Jukema et al, adding:

“Stenosis vs Plaque: We’ve been looking at the wrong winner.

Tackling stenosis above all does not make biological sense.

This study tackles a fundamental question in coronary artery disease:

  • What really predicts outcomes over time?
  • Is it how narrow the artery is… or how much disease is actually there?

Key message

The prognostic value of coronary disease is not static.

Early on: stenosis matters (flow limitation drives events)

Over time: plaque burden becomes dominant

Translation:

The more disease you carry, the more it matters than how tight a single lesion looks.

Why this is disruptive

For decades, cardiology has been built around:

  •  % stenosis
  • ischemia
  • revascularization decisions

But this paper reinforces something deeper:

Atherosclerosis is a diffuse, dynamic disease — not a focal narrowing problem.

The real shift

Plaque burden is:

  • More stable as a biomarker
  • More reflective of total disease biology
  • More predictive in the long term

While stenosis?

  • Fluctuates
  • Is lesion-specific
  • May miss the bigger picture

Clinical implications

If you focus only on stenosis:

  • You treat lesions.

If you focus on plaque burden:

  • You treat the disease.

That’s a completely different strategy.

Bottom line

We are moving from:

‘How tight is the blockage?’

to

‘How much disease is there overall?’

And that shift changes everything:

  • Risk stratification
  • Treatment intensity
  • Prevention strategies

Final thought

  • The artery doesn’t fail because of one stenosis.
  • It fails because of the total plaque ecosystem.

And that’s where the future of imaging – and cardiology – is heading.”

Title: The time-varying prognostic value of stenosis and plaque burden in coronary artery disease

Authors: Ruurt A. Jukema, Teemu Maaniitty, Nick S. Nurmohamed, Pieter G. Raijmakers, Roel Hoek, Roel S. Driessen, R. Nils Planken, Jos Twisk, Pim van der Harst, Maarten J. Cramer, Antti Saraste, Paul Knaapen, Juhani Knuuti, Ibrahim Danad

Filippo Cademartiri: Plaque Burden Is the Dominant Determinant of Long-Term Coronary Risk Beyond Stenosis

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Antti Saraste Atherosclerotic Plaque Coronary Artery Disease Filippo Cademartiri Hematology Hemostasis Hemostasis News Hemostasis Today Ibrahim Danad Jos Twisk Juhani Knuuti Maarten J. Cramer Medicine Nick S. Nurmohamed Paul Knaapen Pieter G. Raijmakers Pim van der Harst R. Nils Planken Roel Hoek Roel S. Driessen Ruurt A. Jukema Teemu Maaniitty
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