Incremental prognostic value of coronary computed tomographic angiography high-risk plaque characteristics in newly symptomatic patients
Incremental prognostic value of coronary computed tomographic angiography high-risk plaque characteristics in newly symptomatic patients
复制标题
冠状动脉计算机断层扫描血管造影高危斑块特征对新出现症状的患者的增量预后价值
DOI：
10.1016/j.jjcc.2015.07.018
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发表时间：
2016
期刊：
影响因子：
2.5
通讯作者：
Narula J
中科院分区：
文献类型：
--
作者：
Fujimoto S;Kondo T;Takamura K;Baber U;Shinozaki T;Nishizaki Y;Kawaguchi Y; Matsumori R;Hiki M;Miyauchi K;Daida H;Hecht H;Stone GW;Narula J
冠状动脉CT血管造影（CTA）中斑块特征的增量预后价值尚未得到很好的评估。本研究旨在确定CTA高风险斑块是否具有预后价值增量的Fragrance风险评分（FRS）和管腔obstructions.MethodsA的严重程度共628例新的症状患者没有已知的冠状动脉疾病进行CTA。他们被随访了平均677天，在此期间有26起心脏事件，包括心源性死亡、急性心肌梗死和因不稳定型心绞痛住院。使用3个考克斯模型和净重新分类指数评估将斑块特征添加到病变血管数量和FRS中的增量预后价值。（c-统计量从65.8%变化到78.6%，p = 0.028），但通过进一步添加斑块特征，（c-统计量从78.6%变化到80.0%，p = 0.812）。然而，通过将斑块特征添加到与风险评分和患病血管数量的线性组合中（来自似然比检验的p= 0.007）以及该模型的Akaike信息标准的最低值来改进模型拟合，表明斑块特征改善了预测准确性和区分角度。更多的受试者重新分类的斑块特征移动到与他们随后的心脏事件状态一致的方向比在一个不一致的direction.ConclusionsEvaluation CTA斑块特征可能会提供增量预后价值的患病血管和FRS的数量。
BackgroundThe incremental prognostic value of the plaque features in coronary computed tomographic angiography (CTA) has not been well assessed. This study was designed to determine whether CTA high-risk plaques have prognostic value incremental to the Framingham risk score (FRS) and the severity of luminal obstruction.MethodsA total of 628 newly symptomatic patients without known coronary artery disease underwent CTA. They were followed for a median of 677 days during which there were 26 cardiac events, including cardiac death, acute myocardial infarction, and hospitalization for unstable angina. Incremental prognostic value of adding plaque characteristics to the number of diseased vessels and the FRS was evaluated using 3 Cox models and net reclassification indexes.ResultsThe discrimination index was significantly increased by adding the number of diseased vessels to the FRS (change in c-statistic from 65.8% to 78.6%,p= 0.028) but not significantly by further adding plaque characteristics (change in c-statistic from 78.6% to 80.0%,p= 0.812). However, improved model-fitting by adding plaque characteristics into the linear combination with risk score and the number of diseased vessels (p= 0.007 from likelihood ratio test) and the lowest value of Akaike's information criteria of that model indicated that plaque characteristics improved both predictive accuracy and discrimination perspective. More subjects reclassified by plaque characteristics were moved to directions consistent with their subsequent cardiac event status than in an inconsistent direction.ConclusionsEvaluation of CTA plaque characteristics may provide incremental prognostic value to the number of diseased vessels and the FRS.