Carotid Plaque Lipid Content and Fibrous Cap Status Predict Systemic CV Outcomes: The MRI Substudy in AIM-HIGH.
Carotid Plaque Lipid Content and Fibrous Cap Status Predict Systemic CV Outcomes: The MRI Substudy in AIM-HIGH.
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DOI：
10.1016/j.jcmg.2016.06.017
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发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
Hatsukami TS
中科院分区：
文献类型：
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作者：
Sun J;Zhao XQ;Balu N;Neradilek MB;Isquith DA;Yamada K;Cantón G;Crouse JR 3rd;Anderson TJ;Huston J 3rd;O'Brien K;Hippe DS;Polissar NL;Yuan C;Hatsukami TS
我们试图研究颈动脉斑块特征是否以及如何预测临床确诊的动脉粥样硬化性疾病患者的全身心血管结局。动脉粥样硬化成像的进步已经允许评估各种斑块特征，与斑块负荷相比，其中一些特征与急性心血管事件的发病机制更直接相关。作为事件驱动临床试验（AIM-HIGH）的一部分，临床确诊动脉粥样硬化疾病的受试者接受了颈动脉多重对比MRI，以检测斑块组织成分和高风险特征。使用考克斯比例风险模型分析MRI测量值与AIM-HIGH主要终点（致死性和非致死性心肌梗死、缺血性卒中、因急性冠脉综合征住院治疗和PCI驱动的血运重建）之间的前瞻性相关性。在招募的232例受试者中，214例（92.2%）具有诊断图像质量的受试者构成了研究人群（平均年龄：61 ± 9岁;男性：82%;他汀类药物用途：94%）。在中位随访35.1个月期间，18例（8.4%）受试者达到AIM-HIGH终点。颈动脉斑块中的高脂质含量（%脂质核心体积每增加一个标准差的风险比：1.57，p = 0.002）和薄/破裂的纤维帽（风险比：4.31，p = 0.003）与AIM-HIGH终点密切相关。斑块内出血的患病率较低（8%），与AIM-HIGH终点轻微相关（风险比：3.00，p = 0.053）。高钙化含量（钙化体积%每增加一个标准差的风险比：0.66，p = 0.20）、斑块负荷指标和临床风险因素与AIM-HIGH终点无显著相关性。调整临床危险因素、斑块负荷或AIM-HIGH随机治疗分配后，颈动脉斑块特征与AIM-HIGH终点之间的相关性变化不大。在临床确诊的动脉粥样硬化性疾病患者中，颈动脉斑块脂质含量和纤维帽状态与全身心血管结局密切相关。颈动脉斑块易损性标志物可能作为系统性动脉粥样硬化血栓形成风险的新的替代标志物。
We sought to investigate whether and what carotid plaque characteristics predict systemic cardiovascular outcomes in patients with clinically established atherosclerotic disease. Advancements in atherosclerosis imaging have allowed assessment of various plaque characteristics, some of which are more directly linked to the pathogenesis of acute cardiovascular events compared to plaque burden. As part of an event-driven clinical trial (AIM-HIGH), subjects with clinically established atherosclerotic disease underwent multicontrast carotid MRI to detect plaque tissue composition and high-risk features. Prospective associations between MRI measurements and the AIM-HIGH primary endpoint (fatal and non-fatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome, and symptom-driven revascularization) were analyzed using Cox proportional hazard models. Of 232 subjects recruited, 214 (92.2%) with diagnostic image quality constituted the study population (mean age: 61±9 years; males: 82%; statin use: 94%). During a median follow-up of 35.1 months, 18 (8.4%) subjects reached the AIM-HIGH endpoint. High lipid content (hazard ratio per one-standard-deviation increase in % lipid core volume: 1.57, p=0.002) and thin/ruptured fibrous cap (hazard ratio: 4.31, p=0.003) in carotid plaques were strongly associated with the AIM-HIGH endpoint. Intraplaque hemorrhage had a low prevalence (8%) and was marginally associated with the AIM-HIGH endpoint (hazard ratio: 3.00, p=0.053). High calcification content (hazard ratio per one-standard-deviation increase in % calcification volume: 0.66, p=0.20), plaque burden metrics, and clinical risk factors were not significantly associated with the AIM-HIGH endpoint. The associations between carotid plaque characteristics and the AIM-HIGH endpoint changed little after adjusting for clinical risk factors, plaque burden, or AIM-HIGH randomized treatment assignment. Among patients with clinically established atherosclerotic disease, carotid plaque lipid content and fibrous cap status were strongly associated with systemic cardiovascular outcomes. Markers of carotid plaque vulnerability may serve as novel surrogate markers for systemic atherothrombotic risk.