Division of Cardiovascular Imaging, Department of Radiology, Bundang Hospital, Seoul National University, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea.
Int J Cardiovasc Imaging. 2012 Dec;28 Suppl 2:93-100. doi: 10.1007/s10554-012-0143-0. Epub 2012 Oct 31.
The purpose of this study was to assess the characteristics and predictors of subclinical coronary atherosclerosis in young adults. The study also evaluated predictors of cardiac events. We retrospectively enrolled 914 self-referred asymptomatic subjects under the age of 45 (552 men, 362 women) who had undergone both coronary CT angiography (CCTA) and coronary artery calcium scoring. Two radiologists analyzed plaque composition and degree of stenosis. For all subjects, we evaluated clinical risk factors and investigated cardiac events. Subclinical coronary atherosclerosis was found in 86 subjects (9.4 %). Among them, 64 subjects (74.4 %) had a single coronary artery plaque. On analysis of individual segments, the most common type of plaque was non-calcified plaque (NCP) (58 %), which was found in 63 subjects (6.9 %). Significant coronary artery stenosis was found in 9 subjects (0.1 %). Predictors of subclinical coronary atherosclerosis were age, male gender, hypertension, and diabetes mellitus. Male gender, diabetes mellitus, and amount of smoking were independent predictors of NCP. High low density lipoprotein cholesterol and calcium scores were also significant predictors of stenosis. Myocardial infarction developed in 1 subject, unstable angina in 2, stable angina in 1, and death in 1 (2.45 cardiac events per 1,000 person-years of follow-up). Multivariate analysis revealed hazard ratios of 2.2 for subclinical coronary atherosclerosis, 49.17 for NCP, and 105.58 for significant stenosis. The prevalence of subclinical coronary atherosclerosis in asymptomatic young adults is not negligible. CCTA has the potential to enhance risk stratification and prediction for coronary artery disease in asymptomatic young adults.
本研究旨在评估年轻成年人亚临床冠状动脉粥样硬化的特征和预测因素。本研究还评估了心脏事件的预测因素。我们回顾性地纳入了 914 名年龄在 45 岁以下（552 名男性，362 名女性）的无症状自我转诊受试者，他们均接受了冠状动脉 CT 血管造影（CCTA）和冠状动脉钙化评分。两名放射科医生分析了斑块成分和狭窄程度。对于所有受试者，我们评估了临床危险因素并调查了心脏事件。在 86 名受试者（9.4%）中发现了亚临床冠状动脉粥样硬化。其中，64 名受试者（74.4%）有单个冠状动脉斑块。在对各个节段进行分析时，最常见的斑块类型是非钙化斑块（NCP）（58%），在 63 名受试者（6.9%）中发现。有 9 名受试者（0.1%）发现有显著的冠状动脉狭窄。亚临床冠状动脉粥样硬化的预测因素是年龄、男性、高血压和糖尿病。男性、糖尿病和吸烟量是 NCP 的独立预测因素。高的低密度脂蛋白胆固醇和钙评分也是狭窄的显著预测因素。1 例发生心肌梗死，2 例发生不稳定型心绞痛，1 例发生稳定型心绞痛，1 例死亡（每 1000 人年随访有 2.45 例心脏事件）。多变量分析显示亚临床冠状动脉粥样硬化的危险比为 2.2，NCP 为 49.17，显著狭窄为 105.58。无症状年轻成年人中亚临床冠状动脉粥样硬化的患病率不容忽视。CCTA 有可能增强无症状年轻成年人冠状动脉疾病的风险分层和预测。
