Quantified coronary total plaque volume from computed tomography angiography provides superior 10-year risk stratification
Quantified coronary total plaque volume from computed tomography angiography provides superior 10-year risk stratification
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DOI：
10.1093/ehjci/jeaa228
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发表时间：
2021-03-01
影响因子：
6.2
通讯作者：
Hausleiter, Joerg
中科院分区：
文献类型：
--
作者：
Deseive, Simon;Kupke, Maximilian;Hausleiter, Joerg
目的：从冠状动脉计算机断层扫描血管造影（CTA）数据集导出的冠状动脉总斑块体积（TPV）定量提供钙化和非钙化冠状动脉粥样硬化负荷的准确和可靠评估。本分析的目的是探讨TPV的长期预测价值。方法和结果TPV进行了量化的1577例患者进行冠状动脉CTA和心血管事件收集在10.5年（四分位数范围6.0-11.4）的后续行动。研究终点包括心源性死亡和急性冠状动脉综合征，59例（3.7%）患者发生。冠状动脉TPV对Morise评分和冠状动脉疾病严重程度评估的临床风险提供了额外的预后价值（C指数从0.744上升到0.769，P=0.03）。结合Morise评分和TPV的基于分类的重新分类方法显示了上级的风险分层（分类净重新分类改善：0.48，95%CI 0.13-0.68，P< 0.001），与单独的Morise评分相比，800例（51%）患者重新分类。研究终点的10年风险为0.6%（95% CI 0-1.3），对于归类为低风险的患者（n = 807），4.8%（95% CI 2.4-7.2）中度风险患者（n = 400），结论冠状动脉CTA定量TPV可改善10年心血管危险分层。
Aims Automated coronary total plaque volume (TPV) quantification derived from coronary computed tomographic angiography (CTA) datasets provide exact and reliable assessment of calcified and non-calcified coronary atheroscler- osis burden. The aim of this analysis was to investigate the long-term predictive value of TPV.Methods and results TPV was quantified in 1577 patients undergoing coronary CTA and cardiovascular events were collected during 10.5 years (interquartile range 6.0-11.4) of follow-up. The study endpoint comprised cardiac death and acute cor- onary syndrome and occurred in 59 (3.7%) patients. Coronary TPV provided additive prognostic value over clinical risk assessed with the Morise Score and coronary artery disease severity (rise in C-index from 0.744 to 0.769, P=0.03). A category-based reclassification approach combining the Morise Score and TPV revealed superior risk stratification (categorical net reclassification improvement: 0.48 with 95% CI 0.13-0.68, P< 0.001) and resulted in reclassification of 800 (51%) patients compared with the Morise Score alone. The 10-year risk for the study endpoint was 0.6% (95% CI 0-1.3) for patients classified as low risk (n = 807), 4.8% (95% CI 2.4-7.2) for patients at intermediate risk (n = 400), and 10.3% (95% CI 6.6-13.9) for patients at high risk (n = 370) using the combined reclassification approach.Conclusion Quantification of TPV from coronary CTA permits an improved 10-year cardiovascular risk stratification.