Heart and Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, MSC 226, Charleston, SC 29401, USA.
Radiology. 2011 Aug;260(2):373-80. doi: 10.1148/radiol.11110158. Epub 2011 Jun 1.
To use coronary computed tomographic (CT) angiography to compare the prevalence, extent, and composition of coronary atherosclerotic lesions in African American and white patients with acute chest pain.
The institutional review board waived the requirement for informed consent for this retrospective, HIPAA-compliant matched-cohort study. The authors analyzed the CT angiographic data of 301 patients (150 consecutive African American patients; 151 white control patients; mean age, 55 years ± 11 [standard deviation]; 33% male) with acute chest pain. Each coronary artery segment was evaluated for presence of atherosclerotic plaque, plaque composition (calcified, noncalcified, or mixed), and stenosis. In addition, the noncalcified plaque volume was quantified by using a threshold-based automated algorithm. The presence and extent of atherosclerotic plaque were compared between the groups by using univariate and multivariate regression analyses.
While there was no significant difference between the African American and white patients with respect to presence of any plaque (118 [79%] of 150 vs 112 [74%] of 151 patients, respectively; P = .36) or presence of stenosis (26 [17%] vs 37 [24%] patients, respectively; P = .13), the African American patients had a significantly higher prevalence (96 [64%] vs 62 [41%] patients, respectively; P < .001) and volume (median volume, 2.2 vs 1.4 mL, respectively; P < .001) of noncalcified plaque, independent of diabetes and other cardiovascular risk factors (odds ratio, 2.45; 95% confidence interval: 1.52, 4.04). In contrast, the African American patients had a lower prevalence of calcified plaque (39 [26%] vs 68 [45%] white patients, P = .001).
Study results suggest that atherosclerotic plaque burden and composition, as measured by using coronary CT angiography, differ between African American and white patients, with relatively more noncalcified disease in African Americans and more calcified disease in white individuals. Further research is warranted to determine whether CT plaque characterization can improve cardiac risk prediction in African Americans.
利用冠状动脉 CT 血管造影术比较急性胸痛的非裔美国人和白人患者冠状动脉粥样硬化病变的发生率、程度和组成。
该回顾性 HIPAA 符合匹配队列研究的机构审查委员会豁免了知情同意书的要求。作者分析了 301 例急性胸痛患者（连续 150 例非裔美国患者；151 例白人对照患者；平均年龄 55 岁±11[标准差]；33%为男性）的 CT 血管造影数据。评估每支冠状动脉节段是否存在粥样硬化斑块、斑块成分（钙化、非钙化或混合）和狭窄。此外，还使用基于阈值的自动算法量化非钙化斑块体积。使用单变量和多变量回归分析比较两组患者的粥样硬化斑块的存在和程度。
非裔美国患者与白人患者在任何斑块的存在方面（分别为 150 例患者中的 118 例[79%]和 151 例患者中的 112 例[74%]；P =.36）或狭窄的存在方面（分别为 26 例[17%]和 37 例[24%]；P =.13）均无显著差异，但非裔美国患者的非钙化斑块的发生率（分别为 96 例[64%]和 62 例[41%]；P <.001）和体积（中位数体积，分别为 2.2 毫升和 1.4 毫升；P <.001）明显更高，且独立于糖尿病和其他心血管危险因素（比值比，2.45；95%置信区间：1.52，4.04）。相比之下，非裔美国患者的钙化斑块发生率较低（分别为 39 例[26%]和 68 例白人患者[45%]；P =.001）。
研究结果表明，非裔美国人和白人患者的冠状动脉粥样硬化斑块负担和组成存在差异，非裔美国人的非钙化病变较多，而白人个体的钙化病变较多。需要进一步研究以确定 CT 斑块特征是否可以改善非裔美国人的心脏风险预测。
