冠状动脉斑块负荷的结果：积极药物治疗的10年随访
Outcome of coronary plaque burden: a 10-year follow-up of aggressive medical management.
作者信息
Goh Victor K, Lau Chu-Pak, Mohlenkamp Stefan, Rumberger John A, Achenbach Stephan, Budoff Matthew J
机构信息
Imaging Centre, Matilda International Hospital, 41 Mount Kellett Road, The Peak, Hong Kong, SAR China.
出版信息
Cardiovasc Ultrasound. 2010 Mar 12;8:5. doi: 10.1186/1476-7120-8-5.
BACKGROUND
The effect of aggressive medical therapy on quantitative coronary plaque burden is not generally known, especially in ethnic Chinese.
AIMS
We reasoned that Cardiac CT could conveniently quantify early coronary atherosclerosis in our patient population, and hypothesized that serial observation could differentiate the efficacy of aggressive medical therapy regarding progression and regression of the atherosclerotic process, as well as evaluating the additional impact of life-style modification and the relative effects of the application of statin therapy.
METHODS
We employed a standardized Cardiac CT protocol to serially scan 113 westernized Hong Kong Chinese individuals (64 men and 49 women) with Chest Pain and positive coronary risk factors. In all cases included for this serial investigation, subsequent evaluation showed no significantly-obstructive coronary disease by functional studies and angiography. After stringent risk factor modification, including aggressive statin therapy to achieve LDL-cholesterol lowering conforming to N.C.E.P. ATP III guidelines, serial CT scans were performed 1-12 years apart for changes in coronary artery calcification (CAC), using the Agatston Score (AS) for quantification.
RESULTS
At baseline, the mean AS was 1413.6 for males (mean age 54.4 years) and 2293.3 for females (mean age 62.4 years). The average increase of AS in the entire study population was 24% per year, contrasting with 16.4% per year on strict risk factor modification plus statin therapy, as opposed to 33.2% per year for historical control patients (p < 0.001). Additionally, 20.4% of the 113 patients demonstrated decreasing calcium scores. Medical therapy also yielded a remarkably low adverse event rate during the follow-up period --- 2 deaths, 2 strokes and only 1 case requiring PCI.
CONCLUSIONS
This study revealed that aggressive medical therapy can positively influence coronary plaque aiding in serial regression of calcium scores.
背景
强化药物治疗对冠状动脉斑块定量负荷的影响尚不明确，尤其是在华裔人群中。
目的
我们推断心脏CT能够方便地对我们的患者群体中的早期冠状动脉粥样硬化进行定量分析，并假设连续观察可以区分强化药物治疗在动脉粥样硬化进程的进展和消退方面的疗效，同时评估生活方式改变的额外影响以及他汀类药物治疗应用的相对效果。
方法
我们采用标准化的心脏CT方案，对113名有胸痛症状且冠状动脉危险因素呈阳性的西化香港华人个体（64名男性和49名女性）进行连续扫描。在纳入本次连续研究的所有病例中，后续通过功能研究和血管造影评估显示无明显阻塞性冠状动脉疾病。在进行严格的危险因素修正后，包括根据美国国家胆固醇教育计划（NCEP）成人治疗组第三次报告（ATP III）指南进行强化他汀类药物治疗以降低低密度脂蛋白胆固醇，每隔1至12年进行一次CT扫描，观察冠状动脉钙化（CAC）的变化，使用阿加斯顿积分（AS）进行量化。
结果
基线时，男性（平均年龄54.4岁）的平均AS为1413.6，女性（平均年龄62.4岁）为2293.3。整个研究人群中AS的平均年增长率为24%，相比之下，在严格的危险因素修正加他汀类药物治疗的情况下为每年16.4%，而历史对照患者为每年33.2%（p < 0.001）。此外，113名患者中有20.4%的人钙积分降低。药物治疗在随访期间的不良事件发生率也非常低——2例死亡，2例中风，仅1例需要进行经皮冠状动脉介入治疗（PCI）。
结论
本研究表明，强化药物治疗可对冠状动脉斑块产生积极影响，有助于钙积分的连续消退。
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