Plaque Characterization by Coronary Computed Tomography Angiography and the Likelihood of Acute Coronary Events in Mid-Term Follow-Up
Plaque Characterization by Coronary Computed Tomography Angiography and the Likelihood of Acute Coronary Events in Mid-Term Follow-Up
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DOI：
10.1016/j.jacc.2015.05.069
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发表时间：
2015-07-28
影响因子：
24
通讯作者：
Narula, Jagat
中科院分区：
文献类型：
--
作者：
Motoyama, Sadako;Ito, Hajime;Narula, Jagat
背景冠状动脉ct血管造影（CTA）证实的正重构和低衰减斑块被认为是高危斑块（HRP）的形态学特征，可以预测急性冠脉综合征（ACS）的短期风险。目的：本研究评估CTA斑块特征是否能预测ACS中期发生的可能性。方法对3158例行CTA的患者进行HRP和显著狭窄（SS）（>= 70%）的评估。对449例患者进行了连续CTA，并评估了斑块进展（PP）。随访期间记录结果（致死性和非致死性ACS）（平均3.9±2.4年）。结果88例（2.8%）患者发生ACS， 294例HRP（+）患者中48例（16.3%），2864例HRP（-）患者中40例（1.4%）发生ACS。ACS在SS（+）患者中（659例中有36例，5.5%）也明显高于SS（-）患者（2499例中有52例，2.1%）。HRP(+)/SS(+)（19%）和HRP(+)/SS(-)（15%）的ACS发生率高于无斑块患者（0.6%）。虽然HRP（-）患者的ACS发病率相对较低，但由HRP（-）病变发展为ACS的累积人数（n = 43）与HRP（+）病变的ACS患者（n = 45）相似。在系列CTA患者中，PP也是ACS的独立预测因子，与HRP(-)/PP（-）患者（0.3%）相比，有HRP（27%; p < 0.0001）和没有HRP（10%）的患者（0.3%）。结论：经cta验证的HRP是ACS的独立预测因子。然而，HRP（-）的ACS患者累积数量与HRP（+）的患者相似。此外，连续CTA检测到的斑块进展是ACS的独立预测因子。(C) 2015年由美国心脏病学会基金会发布。
BACKGROUND Coronary computed tomography angiography (CTA)-verified positive remodeling and low attenuation plaques are considered morphological characteristics of high-risk plaque (HRP) and predict short-term risk of acute coronary syndrome (ACS).OBJECTIVES This study evaluated whether plaque characteristics by CTA predict mid-term likelihood of ACS.METHODS The presence of HRP and significant stenosis (SS) of >= 70% were evaluated in 3,158 patients undergoing CTA. Serial CTA was performed in 449 patients, and plaque progression (PP) was evaluated. Outcomes (fatal and nonfatal ACS) were recorded during follow-up (mean 3.9 +/- 2.4 years).RESULTS ACS occurred in 88 (2.8%) patients: 48 (16.3%) of 294 HRP(+) and 40 (1.4%) of 2,864 HRP(-) patients. ACS was also significantly more frequent in SS(+) (36 of 659; 5.5%) than SS(-) patients (52 of 2,499; 2.1%). HRP(+)/SS(+) (19%) and HRP(+)/SS(-) (15%) had higher rates of ACS compared with no-plaque patients (0.6%). Although ACS incidence was relatively low in HRP(-) patients, the cumulative number of patients with ACS developing from HRP(-) lesions (n = 43) was similar to ACS patients with HRP(+) lesions (n = 45). In patients with serial CTA, PP also was an independent predictor of ACS, with HRP (27%; p < 0.0001) and without HRP (10%) compared with HRP(-)/PP(-) patients (0.3%).CONCLUSIONS CTA-verified HRP was an independent predictor of ACS. However, the cumulative number of ACS patients with HRP(-) was similar to patients with HRP(+). Additionally, plaque progression detected by serial CTA was an independent predictor of ACS. (C) 2015 by the American College of Cardiology Foundation.