Coronary Atherosclerotic Precursors of Acute Coronary Syndromes.
Coronary Atherosclerotic Precursors of Acute Coronary Syndromes.
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DOI：
10.1016/j.jacc.2018.02.079
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发表时间：
2018-06-05
影响因子：
24
通讯作者：
Min JK
中科院分区：
文献类型：
--
作者：
Chang HJ;Lin FY;Lee SE;Andreini D;Bax J;Cademartiri F;Chinnaiyan K;Chow BJW;Conte E;Cury RC;Feuchtner G;Hadamitzky M;Kim YJ;Leipsic J;Maffei E;Marques H;Plank F;Pontone G;Raff GL;van Rosendael AR;Villines TC;Weirich HG;Al'Aref SJ;Baskaran L;Cho I;Danad I;Han D;Heo R;Lee JH;Rivzi A;Stuijfzand WJ;Gransar H;Lu Y;Sung JM;Park HB;Berman DS;Budoff MJ;Samady H;Shaw LJ;Stone PH;Virmani R;Narula J;Min JK
动脉粥样硬化特征与首次急性冠状动脉综合征（ACS）的相关性尚未解释斑块负荷。确定与ACS前兆相关的动脉粥样硬化特征。我们对25，251例接受冠状动脉计算机断层扫描血管造影术（CCTA）的患者进行了一项嵌套病例：对照研究，随访时间超过3.4±2.1年。ACS患者和无既往冠状动脉疾病（CAD）的非事件患者的风险因素和CTA评估的阻塞性（≥50%）CAD倾向匹配为1：1。单独的核心实验室对ACS和罪犯病变进行盲态裁定，并对基线CCTA的直径狭窄%（%DS）、横截面斑块负荷%（PB）、斑块体积（PV）（按成分（钙化、纤维、纤维脂肪和坏死核心））和高风险斑块（HRP）的存在进行定量。我们确定了234对ACS和对照组（62岁，63%男性）。超过65%的ACS患者在基线时患有非梗阻性CAD，52%患有HRP。%DS、横截面PB、纤维脂肪和坏死核心体积以及HRP增加ACS的校正风险比（HR）[1.010/ %DS，95%置信区间（CI）1.005-1.015; 1.008/ %横截面PB，95% CI 1.003-1.013; 1.002/mm 3纤维脂肪斑块，95%CI 1.000-1.003; 1.593/mm 3坏死核心，95%CI 1.219-2.082;所有p <0.05]。在CCTA确定的129个罪犯病变前体中，四分之三显示狭窄<50%，31.0%显示HRP。尽管ACS随%DS的增加而增加，但大多数ACS病例和罪犯病变的前兆是非梗阻性的。斑块评价，包括HRP、PB和斑块成分，可识别高于狭窄严重程度和总斑块负荷的高风险患者。
The association of atherosclerotic features with first acute coronary syndromes (ACS) has not accounted for plaque burden. To identify atherosclerotic features associated with precursors of ACS. We performed a nested case:control study within a cohort of 25,251 patients undergoing coronary computed tomographic angiography (CCTA) with follow-up over 3.4±2.1 years. ACS patients and non-events with no prior coronary artery disease (CAD) were propensity matched 1:1 for risk factors and CCTA-evaluated obstructive (≥50%) CAD. Separate core labs performed blinded adjudication of ACS and culprit lesions and quantification of baseline CCTA for % diameter stenosis (%DS), % cross-sectional plaque burden (PB), plaque volumes (PV) by composition (calcified, fibrous, fibro-fatty, and necrotic core), and presence of high-risk plaques (HRP). We identified 234 ACS and control pairs (62 years, 63% male). Over 65% of ACS patients had non-obstructive CAD at baseline, and 52% had HRP. %DS, cross-sectional PB, fibro-fatty and necrotic core volume, and HRP increased the adjusted hazard ratio (HR) of ACS [1.010 per %DS, 95% confidence interval (CI) 1.005–1.015; 1.008 per % cross-sectional PB, 95% CI 1.003–1.013; 1.002 per mm3 fibro-fatty plaque, 95% CI 1.000–1.003; 1.593 per mm3 necrotic core, 95%CI 1.219–2.082; all p <0.05]. Of the 129 culprit lesion precursors identified by CCTA, three-fourths exhibited <50% stenosis and 31.0% exhibited HRP. Although ACS increases with %DS, most precursors of ACS cases and culprit lesions are non-obstructive. Plaque evaluation, including HRP, PB, and plaque composition, identifies high risk patients above and beyond stenosis severity and aggregate plaque burden.
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影响因子：
24
作者：
Fihn, Stephan D.;Gardin, Julius M.;Yancy, Clyde W.
通讯作者：
Yancy, Clyde W.
影响因子：
24
作者：
Virmani, R;Burke, AP;Kolodgie, FD
通讯作者：
Kolodgie, FD
影响因子：
5.9
作者：
Park, Hyung-Bok;Lee, Byoung Kwon;Chung, Namsik
通讯作者：
Chung, Namsik
影响因子：
24
作者：
Motoyama, Sadako;Sarai, Masayoshi;Narula, Jagat
通讯作者：
Narula, Jagat
DOI：
10.1016/0735-1097(88)90356-7
发表时间：
1988-07-01
影响因子：
24
作者：
AMBROSE, JA;TANNENBAUM, MA;FUSTER, V
通讯作者：
FUSTER, V