Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome
Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome
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DOI：
10.1016/j.jacc.2009.02.068
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发表时间：
2009-06-30
影响因子：
24
通讯作者：
Narula, Jagat
中科院分区：
文献类型：
--
作者：
Motoyama, Sadako;Sarai, Masayoshi;Narula, Jagat
目的通过计算机断层扫描（CT）血管造影研究，我们确定了与急性冠状动脉综合征（ACS）相关的动脉粥样硬化病变的特征。背景ACS罪犯病变的CT特征包括阳性血管重构（PR）和低密度斑块（LVD）。这2个功能已被观察到的病变已经导致ACS，但他们的前瞻性关系ACS还没有以前described.Methods在1,059例接受CT血管造影，动脉粥样硬化病变进行了分析，存在2个功能：PR和PR。计算重塑指数、斑块面积和体积。结果在45例同时显示PR和PR阳性斑块（2特征阳性斑块）的患者中，10例（22.2%）发展为ACS，而在27例同时显示PR和PR阳性斑块（1特征阳性斑块）的患者中，1例（3.7%）发展为ACS。在820例既无PR也无斑块（2特征阴性斑块）的患者中，只有4例（0.5%）发生ACS。167例冠状动脉造影正常的患者中无一例发生急性冠脉事件（p < 0.001）。ACS是PR和/或PR的独立预测指标（风险比：22.8，95%可信区间：6.9 ~ 75.2，p < 0.001）。在2个或1个特征阳性的节段中，导致ACS的节段表现出显著更大的重构指数（126.7 +/- 3.9% vs. 113.4 +/-1.6%，p = 0.003），斑块体积（134.9 ± 14.1 mm（3）vs. 57.8 ± 5.7 mm（3），p < 0.001），体积（20.4 +/- 3.4 mm（3）vs. 1.1 +/- 1.4 mm（3），p < 0.001）和斑块面积/总斑块面积百分比（21.4 +/- 3.7 mm（2）vs. 7.7 +/- 1.5 mm（2），p = 0.001）与未导致ACS的节段相比。CT血管造影显示有衰减斑块的患者与无这些特征的患者相比，随着时间的推移发生ACS的风险更高。（美国科尔心脏病学杂志2009; 54：49-57）（C）2009年美国心脏病学会基金会
Objectives In a computed tomographic (CT) angiography study, we identified the characteristics of atherosclerotic lesions that were associated with subsequent development of acute coronary syndrome (ACS).Background The CT characteristics of culprit lesions in ACS include positive vessel remodeling (PR) and low-attenuation plaques (LAP). These 2 features have been observed in the lesions that have already resulted in ACS, but their prospective relation to ACS has not been previously described.Methods In 1,059 patients who underwent CT angiography, atherosclerotic lesions were analyzed for the presence of 2 features: PR and LAP. The remodeling index, and plaque and LAP areas and volumes were calculated. The plaque characteristics of lesions resulting in ACS during the follow-up of 27 +/- 10 months were evaluated.Results Of the 45 patients showing plaques with both PR and LAP (2-feature positive plaques), ACS developed in 10 (22.2%), compared with 1 (3.7%) of the 27 patients with plaques displaying either feature (1-feature positive plaques). In only 4 (0.5%) of the 820 patients with neither PR nor LAP (2-feature negative plaques) did ACS develop. None of the 167 patients with normal angiograms had acute coronary events (p < 0.001). ACS was independently predicted by PR and/or LAP (hazard ratio: 22.8, 95% confidence interval: 6.9 to 75.2, p < 0.001). Among 2- or 1-feature positive segments, those resulting in ACS demonstrated significantly larger remodeling index (126.7 +/- 3.9% vs. 113.4 +/- 1.6%, p = 0.003), plaque volume (134.9 +/- 14.1 mm(3) vs. 57.8 +/- 5.7 mm(3), p < 0.001), LAP volume (20.4 +/- 3.4 mm(3) vs. 1.1 +/- 1.4 mm(3), p < 0.001), and percent LAP/total plaque area (21.4 +/- 3.7 mm(2) vs. 7.7 +/- 1.5 mm(2), p = 0.001) compared with segments not resulting in ACS.Conclusions The patients demonstrating positively remodeled coronary segments with low-attenuation plaques on CT angiography were at a higher risk of ACS developing over time when compared with patients having lesions without these characteristics. (J Am Coll Cardiol 2009; 54: 49-57) (C) 2009 by the American College of Cardiology Foundation