Nicholls Stephen J, Tuzcu E Murat, Wolski Kathy, Sipahi Ilke, Schoenhagen Paul, Crowe Timothy, Kapadia Samir R, Hazen Stanley L, Nissen Steven E
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Am Coll Cardiol. 2007 Jan 16;49(2):263-70. doi: 10.1016/j.jacc.2006.10.038. Epub 2006 Nov 9.
This study sought to determine the relationship between coronary calcification and plaque progression in response to established medical therapies.
Coronary calcification correlates with the extent of atherosclerosis and predicts clinical outcome.
Atheroma volume was determined in serial intravascular ultrasound pullbacks in matched arterial segments of 776 patients with angiographic coronary artery disease. A calcium grade at baseline was assigned for each image (total 28,876) (0 = no calcium, 1 = calcium with acoustic shadowing <90 degrees and 2 = calcium with shadowing >90 degrees). Patients with a calcium index (average of calcium scores in a pullback) below versus above the median were compared with regard to plaque burden and progression.
Patients with a high calcium index were older (59 vs. 54 years, p < 0.001), more likely to be male (80% vs. 68%, p < 0.001), and more likely to have a history of hypertension (71% vs. 64%, p = 0.03). These patients had a greater percentage atheroma volume (PAV) (45% vs. 34%, p < 0.001), total atheroma volume (TAV) (210 vs. 151 mm3, p < 0.001), and percentage of images with maximal plaque thickness >0.5 mm (93% vs. 72%, p < 0.001). The continuous rate of change in PAV (1.1 +/- 0.4% vs. 0.8 +/- 0.4%, p = 0.34) and TAV (1.7 +/- 2.1% vs. -0.1 +/- 2.2%, p = 0.37) was similar in patients with a lower and higher calcium index, respectively. A lower calcium index was associated with a higher rate of patients showing substantial change in atheroma burden (at least 5% change in PAV, 70% vs. 53%, p < 0.001).
Calcific plaques are more resistant to undergoing changes in size in response to systemic interventions targeting atherosclerotic risk factors.
本研究旨在确定冠状动脉钙化与既定药物治疗后斑块进展之间的关系。
冠状动脉钙化与动脉粥样硬化程度相关，并可预测临床结局。
在776例经血管造影确诊为冠状动脉疾病患者的匹配动脉节段中，通过连续血管内超声回撤测定动脉粥样硬化斑块体积。为每个图像（共28876个）指定基线钙分级（0 = 无钙化，1 = 伴有<90度声影的钙化，2 = 伴有>90度声影的钙化）。比较钙指数（回撤中钙评分的平均值）低于和高于中位数的患者的斑块负荷和进展情况。
钙指数高的患者年龄更大（59岁对54岁，p < 0.001），男性比例更高（80%对68%，p < 0.001），有高血压病史的可能性更大（71%对64%，p = 0.03）。这些患者的动脉粥样硬化斑块体积百分比（PAV）更大（45%对34%，p < 0.001），总动脉粥样硬化斑块体积（TAV）更大（210对151立方毫米，p < 0.001），最大斑块厚度>0.5毫米的图像百分比更高（93%对72%，p < 0.001）。钙指数较低和较高的患者中，PAV（1.1±0.4%对0.8±0.4%，p = 0.34）和TAV（1.7±2.1%对 -0.1±2.2%，p = 0.37）的连续变化率相似。较低的钙指数与动脉粥样硬化斑块负荷有显著变化（PAV至少变化5%）的患者比例较高相关（70%对53%，p < 0.001）。
钙化斑块对针对动脉粥样硬化危险因素的全身干预所引起的大小变化更具抗性。
