Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, Maryland, USA.
Int J Cardiovasc Imaging. 2010 Dec;26(8):923-32. doi: 10.1007/s10554-010-9625-0. Epub 2010 Apr 29.
Increasing coronary artery calcium scores (CACS) are independently associated with cardiac events. Recent advents in coronary computed tomography angiography (CCTA) have allowed us to better characterize individual plaque. Currently, it is unknown if higher CACS are likely to be associated with more calcified or mixed and heterogeneous plaque burden on CCTA. The study population consisted of 1,043 South Korean asymptomatic subjects (49 ± 10 years, 62% men) who underwent CCTA (64-slice MDCT). Plaques were classified on contrast-enhanced CCTA as non-calcified, mixed, and calcified on a per-segment basis according to the modified American Heart Association classification. The majority of the study participants had no coronary calcification (n = 866, 83%), whereas CACS> 0 was observed in 177 participants (17%). Only 40 (5%) participants in absence of CACS had exclusively non-calcified plaque, whereas 10 (1.2%) had significant coronary artery disease. With increasing CACS, study participants were more likely to have exclusively mixed or combination atherosclerotic plaques (P = 0.001). Among individuals with CACS 1-10, the prevalence of at least two coronary segments with mixed plaques was 4%, increasing up to 18 and 41% with CACS of 11-100 and >100. The respective prevalence of ≥2 coronary segments (calcified plaques) with increasing CACS were 6%, 16 and 26% (P = 0.01) and of non-calcified plaques were 6%, 6 and 11% (P = 0.71). In multivariable adjusted analyses, those with CACS >100 were 7.17 times (95% CI: 1.36-37.68) more likely to have ≥2 coronary segments with calcified plaque comparing with CACS 1-10. On the other hand the respective risk was higher for presence of ≥2 segments with mixed plaques (odds ratio: 15.81, 95% CI: 3.14-79.58). Absence of CAC is associated with a negligible presence of any atherosclerotic disease as detected by CCTA in asymptomatic population. A higher CACS is more likely to be associated with heterogeneous coronary plaque (combination of calcified, non-calcified, and mixed plaques), and appears to be more strongly associated with a higher burden of mixed plaque.
冠状动脉钙评分（CACS）的增加与心脏事件独立相关。最近冠状动脉计算机断层扫描血管造影术（CCTA）的进展使我们能够更好地描述个体斑块。目前尚不清楚 CACS 较高是否与 CCTA 上更多的钙化或混合和不均匀斑块负担相关。研究人群包括 1043 名韩国无症状受试者（49±10 岁，62%为男性），他们接受了 CCTA（64 层 MDCT）检查。根据改良的美国心脏协会分类，根据每节段斑块增强 CCTA 将斑块分为非钙化、混合和钙化。大多数研究参与者没有冠状动脉钙化（n=866，83%），而 177 名参与者（17%）的 CACS>0。在没有 CACS 的 40 名（5%）参与者中，只有 40 名（5%）仅存在非钙化斑块，而 10 名（1.2%）患有明显的冠状动脉疾病。随着 CACS 的增加，研究参与者更有可能仅存在混合或组合性动脉粥样硬化斑块（P=0.001）。在 CACS 为 1-10 的个体中，至少有两个冠状动脉节段存在混合斑块的患病率为 4%，随着 CACS 为 11-100 和>100，患病率分别增加到 18%和 41%。随着 CACS 的增加，至少有两个冠状动脉节段（钙化斑块）存在的相应患病率分别为 6%、16%和 26%（P=0.01），而非钙化斑块的患病率分别为 6%、6%和 11%（P=0.71）。在多变量调整分析中，与 CACS 为 1-10 的个体相比，CACS>100 的个体发生≥2 个存在钙化斑块的冠状动脉节段的可能性高 7.17 倍（95%CI：1.36-37.68）。另一方面，存在≥2 个混合斑块节段的风险更高（比值比：15.81，95%CI：3.14-79.58）。在无症状人群中，CCTA 检测到 CAC 缺失与任何动脉粥样硬化疾病的发生率极低相关。较高的 CACS 更可能与异质性冠状动脉斑块（钙化、非钙化和混合斑块的组合）相关，并且似乎与混合斑块的负担增加更为相关。
