High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial.
High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial.
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DOI：
10.1016/j.jacc.2014.05.039
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发表时间：
2014-08-19
影响因子：
24
通讯作者：
Ferencik, Maros
中科院分区：
文献类型：
--
作者：
Puchner, Stefan B.;Liu, Ting;Mayrhofer, Thomas;Truong, Quynh A.;Lee, Hang;Fleg, Jerome L.;Nagurney, John T.;Udelson, James E.;Hoffmann, Udo;Ferencik, Maros
关键词：
为了确定冠状动脉CT血管成像(CTA)检测到的高危斑块是否可以改善急性冠脉综合征(ACS)的早期诊断，而不依赖于急性胸痛患者是否存在明显的CAD。主要目的是确定急诊科CTA检测到的高危斑块特征是否可以提高对急性胸痛但没有心肌缺血或心肌梗死客观证据的患者存在显著的CAD和临床风险评估的独立和递增的ACS诊断确定性。我们将患者随机纳入ROMICAT II试验的CCTA组。读者对冠状动脉CTA进行定性评估，包括非梗阻性冠状动脉病变(1-49%狭窄)、显著冠状动脉病变(≥50%或≥70%狭窄)，以及至少一种高危斑块的存在(阳性重塑、低-lt；30 Hounsfield Units斑块、餐巾环征、钙斑斑块)。在Logistic回归分析中，我们确定了在指数住院期间高危斑块与ACS[心肌梗死(MI)或不稳定型心绞痛(UAP)]的相关性，以及这是否独立于显著的CAD和临床风险评估。在接受冠状动脉CTA检查的472例患者中，37例(平均年龄53.9±8.0岁，男性52.8%)发生了急性冠脉综合征(7.8%；MI n=5，UAP n=32)。冠脉病变262例(55.5%)，其中非梗阻性冠脉病变217例(46.0%)，重度冠脉病变伴≥50%狭窄45例(9.5%)。高危斑块在急性冠脉综合征患者中更为常见，在调整了≥50%狭窄(OR38.695%CI14.2-104.7，p<；0.001)和临床风险评估(年龄、性别、心血管危险因素的数量)后，高危斑块仍然是急性冠脉综合征的显著预测因素(OR8.9，95%CI1.8-43.3，p=0.006)。在调整了≥70%的狭窄后，也观察到了类似的结果。在急性胸痛但初始心电图和肌钙蛋白阴性的患者中，冠状动脉CTA上存在高风险斑块增加了与显著的CAD和临床风险评估(年龄、性别和心血管危险因素数量)无关的急性冠脉综合征的可能性。
To determine whether high-risk plaque as detected by coronary computed tomography angiography (CTA) permits improved early diagnosis of acute coronary syndrome (ACS) independent to the presence of significant CAD in acute chest pain patients. The primary aim was to determine whether high-risk plaque features, as detected by CTA in the emergency department, may improve diagnostic certainty of ACS independent and incremental to the presence of significant CAD and clinical risk assessment in patients with acute chest pain but without objective evidence of myocardial ischemia or myocardial infarction. We included patients randomized to the CCTA arm of ROMICAT II trial. Readers assessed coronary CTA qualitatively for the presence of non-obstructive CAD (1-49% stenosis), significant CAD (≥50% or ≥70% stenosis), and the presence of at least 1 of the high-risk plaque features (positive remodeling, low < 30 Hounsfield Units plaque, napkin-ring sign, spotty calcium). In logistic regression analysis, we determined the association of high-risk plaque with ACS [myocardial infarction (MI) or unstable angina pectoris (UAP)] during the index hospitalization and whether this was independent of significant CAD and clinical risk assessment. Overall 37 of 472 patients who underwent coronary CTA with diagnostic image quality (mean age 53.9±8.0 years, 52.8% men) had ACS (7.8%; MI n=5, UAP n=32)]. CAD was present in 262 (55.5%) patients [non-obstructive CAD 217 (46.0%) patients, significant CAD with ≥50% stenosis 45 (9.5%) patients]. High-risk plaques were more frequent in patients with ACS and remained a significant predictor of ACS (OR 8.9, 95% CI 1.8-43.3, p=0.006) after adjusting for ≥50% stenosis (OR 38.6, 95% CI 14.2-104.7, p<0.001) and clinical risk assessment (age, gender, number of cardiovascular risk factors). Similar results were observed after adjusting for ≥70% stenosis. In patients presenting to the ED with acute chest pain but negative initial electrocardiogram and troponin, presence of high-risk plaque on coronary CTA increases the likelihood of ACS independent of significant CAD and clinical risk assessment (age, gender, and number of cardiovascular risk factors).
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