Residual Risk in Non-ST-Segment Elevation Acute Coronary Syndrome: Quantitative Plaque Analysis at Coronary CT Angiography
Residual Risk in Non-ST-Segment Elevation Acute Coronary Syndrome: Quantitative Plaque Analysis at Coronary CT Angiography
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DOI：
10.1148/radiol.230124
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发表时间：
2023-08-01
期刊：
影响因子：
19.7
通讯作者：
Lu, Bin
中科院分区：
文献类型：
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作者：
Lu, Zhong-Fei;Yin, Wei-Hua;Lu, Bin
背景资料：血管内成像检测到的富脂斑块与非ST段抬高（NSTE）急性冠状动脉综合征（ACS）患者的不良心血管事件相关。但是关于冠状动脉CT血管造影（CCTA）在NSTE ACS中的预后意义的证据是有限的。目的：评估CCTA中反映NSTE ACS个体中非血运重建斑块中脂质含量的定量变量是否可能是随后非血运重建斑块相关的主要不良心血管事件（MACE）的预测因子。材料和方法：在这项多中心前瞻性队列研究中，从2017年11月至2019年1月，入组了诊断为NSTE ACS的个体（不包括极高风险的个体），并在1天内进行有创冠状动脉造影（伊卡）前进行了CCTA。脂核定义为斑块中衰减小于30 HU的区域。MACE定义为心源性死亡、心肌梗死、因不稳定型心绞痛住院和血运重建。参与者在6个月，12个月和此后每年随访至少3年（截至2022年7月）。采用考克斯比例风险回归模型进行多变量分析，以确定参与者和斑块水平的脂质核心负荷、脂质核心体积和未来非血运重建斑块相关MACE之间的相关性。（平均年龄，57.9岁+/- 11.1 [SD]; 263名男性）纳入分析，中位随访期为4.0年（IQR，3.6-4.4年）。4年非血运重建斑块相关MACE发生率为23.9%（95% CI：19.1，28.5）。核心脂质负担（风险比[HR]，12.6; 95% CI：4.6，34.3）是参与者水平的独立预测因子，最佳阈值为2.8%。脂质核心负荷（HR，12.1; 95% CI：6.6，22.3）和体积（HR，11.0; 95%CI：6.5，18.4）是斑块水平的独立预测因子，最佳阈值分别为7.2%和10.1 mm 3。在NSTE ACS中，CCTA斑块脂质含量的定量分析独立预测了参与者和斑块未来非血运重建斑块相关MACE的风险较高。
Background: Lipid-rich plaques detected with intravascular imaging are associated with adverse cardiovascular events in patients with non-ST-segment elevation (NSTE) acute coronary syndrome (ACS). But evidence about the prognostic implication of coronary CT angiography (CCTA) in NSTE ACS is limited.Purpose: To assess whether quantitative variables at CCTA that reflect lipid content in nonrevascularized plaques in individuals with NSTE ACS might be predictors of subsequent nonrevascularized plaque-related major adverse cardiovascular events (MACEs).Materials and Methods: In this multicenter prospective cohort study, from November 2017 to January 2019, individuals diagnosed with NSTE ACS (excluding those at very high risk) were enrolled and underwent CCTA before invasive coronary angiography (ICA) within 1 day. Lipid core was defined as areas with attenuation less than 30 HU in plaques. MACEs were defined as cardiac death, myocardial infarction, hospitalization for unstable angina, and revascularization. Participants were followed up at 6 months, 12 months, and annually thereafter for at least 3 years (ending by July 2022). Multivariable analysis using Cox proportional hazards regression models was performed to determine the association between lipid core burden, lipid core volume, and future nonrevascularized plaque-related MACEs at both the participant and plaque levels.Results: A total of 342 participants (mean age, 57.9 years +/- 11.1 [SD]; 263 male) were included for analysis with a median follow-up period of 4.0 years (IQR, 3.6-4.4 years). The 4-year nonrevascularized plaque-related MACE rate was 23.9% (95% CI: 19.1, 28.5). Lipid core burden (hazard ratio [HR], 12.6; 95% CI: 4.6, 34.3) was an independent predictor at the participant level, with an optimum threshold of 2.8%. Lipid core burden (HR, 12.1; 95% CI: 6.6, 22.3) and volume (HR, 11.0; 95% CI: 6.5, 18.4) were independent predictors at the plaque level, with an optimum threshold of 7.2% and 10.1 mm3, respectively.Conclusion: In NSTE ACS, quantitative analysis of plaque lipid content at CCTA independently predicted participants and plaques at higher risk for future nonrevascularized plaque-related MACEs.