无可改变的冠状动脉疾病危险因素患者中冠状动脉CT血管造影的长期预后效用：CONFIRM国际多中心注册研究5年随访结果
Long term prognostic utility of coronary CT angiography in patients with no modifiable coronary artery disease risk factors: Results from the 5 year follow-up of the CONFIRM International Multicenter Registry.
作者信息
Cheruvu Chaitu, Precious Bruce, Naoum Christopher, Blanke Philipp, Ahmadi Amir, Soon Jeanette, Arepalli Chesnaldey, Gransar Heidi, Achenbach Stephan, Berman Daniel S, Budoff Matthew J, Callister Tracy Q, Al-Mallah Mouaz H, Cademartiri Filippo, Chinnaiyan Kavitha, Rubinshtein Ronen, Marquez Hugo, DeLago Augustin, Villines Todd C, Hadamitzky Martin, Hausleiter Joerg, Shaw Leslee J, Kaufmann Philipp A, Cury Ricardo C, Feuchtner Gudrun, Kim Yong-Jin, Maffei Erica, Raff Gilbert, Pontone Gianluca, Andreini Daniele, Chang Hyuk-Jae, Min James K, Leipsic Jonathon
机构信息
Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
出版信息
J Cardiovasc Comput Tomogr. 2016 Jan-Feb;10(1):22-7. doi: 10.1016/j.jcct.2015.12.005. Epub 2015 Dec 15.
BACKGROUND
Coronary computed tomography angiography (coronary CTA) can prognosticate outcomes in patients without modifiable risk factors over medium term follow-up. This ability was driven by major adverse cardiovascular events (MACE).
OBJECTIVE
Determine if coronary CTA could discriminate risk of mortality with longer term follow-up. In addition we sought to determine the long-term relationship to MACE.
METHODS
From 12 centers, 1884 patients undergoing coronary CTA without prior coronary artery disease (CAD) or any modifiable CAD risk factors were identified. The presence of CAD was classified as none (0% stenosis), mild (1% to 49% stenosis) and obstructive (≥50% stenosis severity). The primary endpoint was all-cause mortality and the secondary endpoint was MACE. MACE was defined as the combination of death, nonfatal myocardial infarction, unstable angina, and late target vessel revascularization (>90 days).
RESULTS
Mean age was 55.6 ± 14.5 years. At mean 5.6 ± 1.3 years follow-up, 145(7.7%) deaths occurred. All-cause mortality demonstrated a dose-response relationship to the severity and number of coronary vessels exhibiting CAD. Increased mortality was observed for >1 segment non-obstructive CAD (hazard ratio [HR]:1.73; 95% confidence interval [CI]: 1.07-2.79; p = 0.025), obstructive 1&2 vessel CAD (HR: 1.70; 95% CI: 1.08-2.71; p = 0.023) and 3-vessel or left main CAD (HR: 2.87; 95% CI: 1.57-5.23; p = 0.001). Both obstructive CAD (HR: 6.63; 95% CI: 3.91-11.26; p < 0.001) and non-obstructive CAD (HR: 2.20; 95% CI: 1.31-3.67; p = 0.003) predicted MACE with increased hazard associated with increasing CAD severity; 5.60% in no CAD, 13.24% in non-obstructive and 36.28% in obstructive CAD, p < 0.001 for trend.
CONCLUSIONS
In individuals being assessed for CAD with no modifiable risk factors, all-cause mortality in the long term (>5 years) was predicted by the presence of more than 1 segment of non-obstructive plaque, obstructive 1- or 2-vessel CAD and 3 vessel/left main CAD. Any CAD, whether non-obstructive or obstructive, predicted MACE over the same time period.
背景
冠状动脉计算机断层扫描血管造影术（冠状动脉CTA）可在中期随访中对无可改变风险因素的患者的预后进行预测。这种能力是由主要不良心血管事件（MACE）驱动的。
目的
确定冠状动脉CTA在更长时间的随访中是否能够区分死亡风险。此外，我们试图确定其与MACE的长期关系。
方法
从12个中心识别出1884例接受冠状动脉CTA检查且无既往冠状动脉疾病（CAD）或任何可改变的CAD风险因素的患者。CAD的存在被分类为无（0%狭窄）、轻度（1%至49%狭窄）和阻塞性（≥50%狭窄严重程度）。主要终点是全因死亡率，次要终点是MACE。MACE被定义为死亡、非致命性心肌梗死、不稳定型心绞痛和晚期靶血管血运重建（>90天）的组合。
结果
平均年龄为55.6±14.5岁。在平均5.6±1.3年的随访中，发生了145例（7.7%）死亡。全因死亡率与显示CAD的冠状动脉血管的严重程度和数量呈剂量反应关系。对于>1节段非阻塞性CAD，观察到死亡率增加（风险比[HR]：1.73；95%置信区间[CI]：1.07 - 2.79；p = 0.025），1或2支血管阻塞性CAD（HR：1.70；95% CI：1.08 - 2.71；p = 0.023）以及3支血管或左主干CAD（HR：2.87；95% CI：1.57 - 5.23；p = 0.001）。阻塞性CAD（HR：6.63；95% CI：3.91 - 11.26；p < 0.001）和非阻塞性CAD（HR：2.20；95% CI：1.31 - 3.67；p = 0.003）均预测了MACE，且随着CAD严重程度增加风险升高；无CAD者为5.60%，非阻塞性CAD者为13.24%，阻塞性CAD者为36.28%，趋势p < 0.001。
结论
在评估无可改变风险因素的CAD患者中，长期（>5年）全因死亡率可通过存在超过1节段的非阻塞性斑块、1或2支血管阻塞性CAD以及3支血管/左主干CAD来预测。任何CAD，无论非阻塞性还是阻塞性，在同一时期均预测了MACE。
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