Long-term prognostic value of morphological plaque features on coronary computed tomography angiography
Long-term prognostic value of morphological plaque features on coronary computed tomography angiography
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DOI：
10.1093/ehjci/jez238
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发表时间：
2020-03-01
影响因子：
6.2
通讯作者：
Hadamitzky, Martin
中科院分区：
文献类型：
--
作者：
Finck, Tom;Stojanovic, Antonija;Hadamitzky, Martin
目的：研究斑块形态学特征在临床风险和冠状动脉狭窄水平之外的增量预后价值。虽然与冠状动脉狭窄程度相关，但大多数心脏事件发生在非阻塞性斑块破裂和连续血管血栓形成的基础上。因此，识别易损斑块是至关重要的心血管风险预测和治疗decisions.Methods和结果A共1615例患者怀疑，但以前没有诊断为冠状动脉疾病（CAD）的冠状动脉计算机断层扫描血管造影和形态斑块特征进行了评估。平均随访时间为10.5年（四分位距9.2-11.4）。采用考克斯比例风险分析法分析心源性死亡和非致死性心肌梗死的复合终点。51例患者达到研究终点（36例心脏性死亡，15例非致死性心肌梗死）。除定量参数（存在任何钙化/非钙化斑块或斑块负荷升高）外，斑块形态特征（如斑点状或大体钙化模式和纳金环征（NRS））可预测事件。然而，只有斑点状钙化斑块和NRS可以提供超出临床风险和冠状动脉狭窄程度的附加预后价值。在逐步方法中，终点预测超出临床风险通过纳入CAD严重程度（chi（2）为27.5，P < 0.001）和进一步区分斑点状钙化斑块（chi（2）为3.89，P = 0.049）结论：通过鉴别心血管危险因素的存在，可以在临床危险和冠状动脉狭窄水平之外提高心血管危险预测。斑点状钙化斑块因此，加强预防性抗动脉粥样硬化治疗似乎是必要的患者冠状动脉斑块显示斑点状钙化。
Aims To investigate the incremental prognostic value of morphological plaque features beyond clinical risk and coronary stenosis levels. Although associated with the degree of coronary stenosis, most cardiac events occur on the basis of ruptured non-obstructive plaques and consecutive vessel thrombosis. As such, identification of vulnerable plaques is paramount for cardiovascular risk prediction and treatment decisions.Methods and results A total of 1615 patients with suspected but not previously diagnosed coronary artery disease (CAD) were examined by coronary computed tomography angiography and morphological plaque features were assessed. Mean follow-up was 10.5 (interquartile range 9.2-11.4) years. Cox proportional hazards analysis was used for the composite endpoint of cardiac death and non-fatal myocardial infarction. The study endpoint was reached in 51 patients (36 cardiac deaths, 15 non-fatal myocardial infarctions). In addition to quantitative parameters (presence of any calcified/non-calcified plaque or elevated plaque load), morphologic plaque features such as a spotty or gross calcification pattern and napkin-ring sign (NRS) were predictive for events. However, only spotty calcified plaques and NRS could confer additive prognostic value beyond clinical risk and coronary stenosis level. In a stepwise approach, endpoint prediction beyond clinical risk (Morise score) could be improved by inclusion of CAD severity (chi(2) of 27.5, P < 0.001) and further discrimination for spotty calcified plaques (chi(2) of 3.89, P = 0.049).Conclusion Improved cardiovascular risk prediction beyond clinical risk and coronary stenosis levels can be made by discriminating for the presence of spotty calcified plaques. Thus, an intensified prophylactic anti-atherosclerotic treatment appears to be warranted in patients with coronary plaques that show spotty calcifications.