Centro Cardiologico Monzino, IRCCS, via C. Parea 4, 20138 Milan, Italy.
Department of Clinical Sciences and Community Health, Cardiovascular Section,University of Milan, Milan, Italy.
Eur Heart J Cardiovasc Imaging. 2017 Oct 1;18(10):1170-1178. doi: 10.1093/ehjci/jew200.
Recent studies suggested that even non-obstructive coronary artery disease (CAD) increases major cardiovascular adverse events (MACE) rate. Aim of this study was to evaluate whether coronary computed tomography angiography (CCTA) may detect specific plaque characteristics that may affect prognosis in patients with non-obstructive CAD.
We enrolled 245 patients who underwent CCTA between April 2004 and April 2007 for suspected CAD and were found to have non-obstructive CAD. Positive remodelling index (PRI), low-attenuation plaque (LAP), plaque burden (PB), spotty calcification (SC), and napkin-ring sign (NRS) have been evaluated for each coronary plaque detected. Acute coronary syndrome, all-cause/cardiac death, and very late elective revascularization (vl-ER) were the endpoints of the study.
A total of 28 events were recorded (2 STEMI, 4 NSTEMI, 6 UA, 2 cardiac deaths, 4 non-cardiac death, and 10 vl-ERs) at long-term follow-up (98 ± 20 months). When adjusted for significant clinical variables PRI > 1.4 (HR 3.31 CI 95% 1.11-9.91, P = 0.0392), LAP (HR 8.45 CI 95% 2.22-32.21, P = 0.0019), PB > 0.7 (HR 5.25 CI 95% 1.45-19.03, P = 0.0120), and NRS (HR 12.52 CI 95% 1.51-103.90, P = 0.0198) were still significantly associated with higher rate of hard cardiac events at follow-up. The Kaplan-Meyer curves confirmed lower cumulative hard cardiac events-free survival in patients presenting at least one coronary plaque with two or more high-risk characteristics when compared with patients with no lesion with more than one high-risk plaque characteristics (log-rank P < 0.0001).
High-risk plaque characteristics at CCTA (PRI > 1.4, PB > 0.7, LAP, and NRS) seem to be promising for risk stratification of patients with non-obstructive CAD.
最近的研究表明，即使是非阻塞性冠状动脉疾病（CAD）也会增加主要心血管不良事件（MACE）的发生率。本研究旨在评估冠状动脉计算机断层扫描血管造影（CCTA）是否可以检测出特定的斑块特征，这些特征可能会影响非阻塞性 CAD 患者的预后。
我们招募了 245 名患者，他们在 2004 年 4 月至 2007 年 4 月期间因疑似 CAD 接受了 CCTA 检查，结果发现存在非阻塞性 CAD。已经评估了每个冠状动脉斑块的阳性重塑指数（PRI）、低衰减斑块（LAP）、斑块负担（PB）、点状钙化（SC）和餐巾环征（NRS）。急性冠状动脉综合征、全因/心脏死亡和非常晚期择期血运重建（vl-ER）是本研究的终点。
在长期随访（98±20 个月）中记录了 28 例事件（2 例 STEMI、4 例 NSTEMI、6 例 UA、2 例心脏死亡、4 例非心脏死亡和 10 例 vl-ER）。在校正了显著的临床变量后，PRI＞1.4（HR 3.31，95%CI 1.11-9.91，P=0.0392）、LAP（HR 8.45，95%CI 2.22-32.21，P=0.0019）、PB＞0.7（HR 5.25，95%CI 1.45-19.03，P=0.0120）和 NRS（HR 12.52，95%CI 1.51-103.90，P=0.0198）仍然与随访时更高的硬心脏事件发生率显著相关。Kaplan-Meier 曲线证实，与没有病变但有两个或更多高危斑块特征的患者相比，至少有一个具有两种或更多高危斑块特征的冠状动脉斑块的患者的累积硬心脏事件无生存曲线较低（对数秩 P＜0.0001）。
CCTA 中的高危斑块特征（PRI＞1.4、PB＞0.7、LAP 和 NRS）似乎可用于非阻塞性 CAD 患者的风险分层。
