Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California, USA.
Am J Cardiol. 2011 Jan;107(1):10-6. doi: 10.1016/j.amjcard.2010.08.034.
It was previously reported that event-free survival rates of symptomatic patients with coronary artery disease (CAD) diagnosed by computed tomographic angiography decreased incrementally from normal coronary arteries to obstructive CAD. The aim of this study was to investigate the clinical outcomes of symptomatic patients with nonobstructive CAD with luminal stenoses of 1% to 49% on the basis of coronary plaque morphology in an outpatient setting. Among 3,499 consecutive symptomatic subjects who underwent computed tomographic angiography, 1,102 subjects with nonobstructive CAD (mean age 59 ± 14 years, 69.9% men) were prospectively followed for a mean of 78 ± 12 months. Coronary plaques were defined as noncalcified, mixed, and calcified per patient. Multivariate Cox proportional-hazards models were developed to predict all-cause mortality. The death rate of patients with nonobstructive CAD was 3.1% (34 deaths). The death rate increased incrementally from calcified plaque (1.4%) to mixed plaque (3.3%) to noncalcified plaque (9.6%), as well as from single- to triple-vessel disease (p <0.001). In subjects with mixed or calcified plaques, the death rate increased with the severity of coronary artery calcium from 1 to 9 to ≥ 400. The risk-adjusted hazard ratios of all-cause mortality in patients with nonobstructive CAD were 3.2 (95% confidence interval 1.3 to 8.0, p = 0.001) for mixed plaques and 7.4 (95% confidence interval 2.7 to 20.1, p = 0.0001) for noncalcified plaques compared with calcified plaques. The areas under the receiver-operating characteristic curve to predict all-cause mortality were 0.75 for mixed and 0.86 for noncalcified coronary lesions. In conclusion, this study demonstrates that the presence of noncalcified and mixed coronary plaques provided incremental value in predicting all-cause mortality in symptomatic subjects with nonobstructive CAD independent of age, gender, and conventional risk factors.
先前有报道称，通过计算机断层血管造影术诊断为冠心病（CAD）的有症状患者，其无事件生存率从正常冠状动脉到阻塞性 CAD 逐渐降低。本研究旨在调查门诊环境下，冠状动脉斑块形态学基础上，有症状的非阻塞性 CAD 患者，管腔狭窄 1%至 49%的临床结局。在连续 3499 例有症状的接受计算机断层血管造影术的患者中，前瞻性随访了 1102 例非阻塞性 CAD 患者（平均年龄 59±14 岁，69.9%为男性），平均随访时间为 78±12 个月。每例患者的冠状动脉斑块均定义为非钙化斑块、混合斑块和钙化斑块。采用多变量 Cox 比例风险模型预测全因死亡率。非阻塞性 CAD 患者的死亡率为 3.1%（34 例死亡）。死亡率从钙化斑块（1.4%）逐渐升高至混合斑块（3.3%）和非钙化斑块（9.6%），以及从单支病变到三支病变（p<0.001）。在有混合或钙化斑块的患者中，随着冠状动脉钙严重程度从 1 至 9 至≥400，死亡率逐渐升高。非阻塞性 CAD 患者的全因死亡风险调整后的危险比，与钙化斑块相比，混合斑块为 3.2（95%置信区间为 1.3 至 8.0，p=0.001），非钙化斑块为 7.4（95%置信区间为 2.7 至 20.1，p=0.0001）。预测全因死亡率的受试者工作特征曲线下面积，混合斑块为 0.75，非钙化斑块为 0.86。总之，本研究表明，在有症状的非阻塞性 CAD 患者中，与钙化斑块相比，非钙化和混合冠状动脉斑块的存在提供了预测全因死亡率的额外价值，独立于年龄、性别和传统危险因素。
