Plaque Morphology as Predictor of Late Plaque Events in Patients With Asymptomatic Type 2 Diabetes A Long-Term Observational Study
Plaque Morphology as Predictor of Late Plaque Events in Patients With Asymptomatic Type 2 Diabetes A Long-Term Observational Study
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DOI：
10.1016/j.jcmg.2018.02.025
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发表时间：
2019-07-01
影响因子：
14
通讯作者：
Lewis, Basil S.
中科院分区：
文献类型：
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作者：
Halon, David A.;Lavi, Idit;Lewis, Basil S.
目的：作者使用冠状动脉计算机断层血管造影（CTA）来确定斑块特征，预测无症状2型糖尿病患者急性冠脉综合征（ACS）的个体晚期斑块事件。背景：在冠状动脉疾病患者中，CTA斑块特征可以预测患者中期事件。方法55 ~ 74岁无冠状动脉疾病史的无症状糖尿病患者（630例）接受64层CTA基线检查和详细的斑块水平分析。所有随后的临床事件均被记录和判定。在发生ACS的患者中，罪魁祸首斑块是在侵入性血管造影中发现的，其前体位于基线CTA上。预测acs相关的罪魁祸首斑块事件的斑块特征通过对住院患者斑块聚类和竞争事件的时间到事件分析。结果在499名受试者的2242个斑块中，24名受试者在中位随访9.2年（四分位数间隔8.4 - 9.8年）期间发现24个ACS罪魁祸首斑块。斑块体积（上四分位数vs下四分位数风险比[HR]: 6.9； 95%可信区间[CI]: 1.6 - 30.8; p = 0.011），低密度斑块含量百分比= 2个风险预测因子)，非HRP患者中1866例中有11例（0.6%）（p < 0.0001）， 343例狭窄部位中有12例（3.5%）（>= 50%），非狭窄部位中有12例（0.6%）（p < 0.0001）， 131例HRP狭窄患者中有7例（5.3%）（p < 0.0001）。在130例（20.6%）受试者中，基线CTA检查未发现冠状动脉斑块。结论：在无症状2型糖尿病患者中，CTA斑块体积、低密度斑块含量百分比和轻度钙化预测晚期斑块事件。额外存在的管腔狭窄增加了急性事件的可能性。(C) 2019年由美国心脏病学会基金会发布。
OBJECTIVES The authors used coronary computed tomography angiography (CTA) to determine plaque characteristics predicting individual late plaque events precipitating acute coronary syndromes (ACS) in a cohort of asymptomatic type 2 diabetic patients.BACKGROUND In patients with coronary artery disease, CTA plaque characteristics may predict mid-term patient events.METHODS Asymptomatic patients with diabetes 55 to 74 years of age with no history of coronary artery disease (N = 630) underwent baseline 64-slice CTA and detailed plaque level analysis. All subsequent clinical events were recorded and adjudicated. In patients who developed ACS, culprit plaque was identified at invasive angiography and its precursor located on the baseline CTA. Plaque characteristics predicting an ACS-associated culprit plaque event were analyzed by time to event accounting for inpatient clustering of plaques and competing events.RESULTS Among 2,242 plaques in 499 subjects, 24 ACS culprit plaques were identified in 24 subjects during median follow-up of 9.2 years (interquartile range: 8.4 to 9.8 years). Plaque volume (upper vs. lower quartile hazard ratio [HR]: 6.9; 95% confidence interval [CI]: 1.6 to 30.8; p = 0.011), percentage of low-density plaque content = 2 risk predictors) versus 11 of 1,866 (0.6%) in non-HRPs (p < 0.0001), at 12 of 343 (3.5%) stenotic sites (>= 50%) versus 12 of 1,899 (0.6%) nonstenotic sites (p < 0.0001) and in 7 of 131 (5.3%) HRP with stenosis (p < 0.0001 vs. all others). In 130 (20.6%) subjects, no coronary plaque was present on baseline CTA.CONCLUSIONS In asymptomatic patients with type 2 diabetes, CTA plaque volume, percent low-density plaque content, and mild calcification predicted late plaque events. The additional presence of luminal stenosis increased the probability of an acute event. (C) 2019 by the American College of Cardiology Foundation.