冠状动脉 CT 血管造影检查排除非阻塞性冠状动脉疾病可改善风险分层和他汀类药物治疗的分配。
Nonobstructive Coronary Artery Disease by Coronary CT Angiography Improves Risk Stratification and Allocation of Statin Therapy.
机构信息
Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine, Yale-New Haven Hospital, Yale Medical School, New Haven, Connecticut.
Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
出版信息
JACC Cardiovasc Imaging. 2017 Sep;10(9):1031-1038. doi: 10.1016/j.jcmg.2016.10.022. Epub 2017 Mar 15.
OBJECTIVES
This study sought to determine prognostic value of nonobstructive coronary artery disease (CAD) for atherosclerotic cardiovascular disease (ASCVD) events and to determine whether incorporation of this information into the pooled cohort equation reclassifies recommendations for statin therapy as defined by the 2013 guidelines for cholesterol management of the American College of Cardiology and American Heart Association (ACC/AHA).
BACKGROUND
Detection of nonobstructive CAD by coronary computed tomography angiography may improve risk stratification and permit individualized and more appropriate allocation of statin therapy.
METHODS
This study determined the pooled hazard ratio of nonobstructive CAD for ASCVD events from published studies and incorporated this information into the ACC/AHA pooled cohort equation. The study calculated revised sex- and ethnicity-based 10-year ASCVD risk and determined boundaries corresponding to the original 7.5% risk for ASCVD events. It also assessed reclassification for statin eligibility by incorporating the results from meta-analysis to individual patients from a separate cohort.
RESULTS
This study included 2 studies (2,295 subjects; 66% male; prevalence of nonobstructive CAD, 47%; median follow-up, 49 months; 67 ASCVD events). The hazard ratio of nonobstructive CAD for ASCVD events was 3.2 (95% confidence interval: 1.5 to 6.7). Incorporation of this information into the pooled cohort equation resulted in reclassification toward statin eligibility in individuals with nonobstructive CAD, with an original ASCVD score of 3.0% and 5.9% or higher in African-American women and men and a score of 4.4% and 4.6% or higher in Caucasian women and men, respectively. The absence of nonobstructive CAD resulted in reclassification toward statin ineligibility if the original ASCVD score was as 10.0% and 17.9% or lower in African-American women and men and 13.7% and 14.3% or lower in Caucasian women and men, respectively. Reclassification is observed in 14% of patients.
CONCLUSIONS
Detection of nonobstructive CAD by coronary computed tomography angiography improves risk stratification and permits individualized and more appropriate allocation of statin therapy across sex and ethnicity groups.
目的
本研究旨在确定非阻塞性冠状动脉疾病（CAD）对动脉粥样硬化性心血管疾病（ASCVD）事件的预后价值，并确定将此信息纳入美国心脏病学会和美国心脏协会（ACC/AHA）2013 年胆固醇管理指南定义的他汀类药物治疗建议的 pooled cohort equation 中是否重新分类。
背景
冠状动脉计算机断层血管造影术（CCTA）检测到非阻塞性 CAD 可能会改善风险分层，并允许对他汀类药物治疗进行个体化和更恰当的分配。
方法
本研究通过已发表的研究确定了非阻塞性 CAD 对 ASCVD 事件的 pooled hazard ratio，并将此信息纳入 ACC/AHA pooled cohort equation 中。该研究计算了经修订的基于性别和种族的 10 年 ASCVD 风险，并确定了与原始 ASCVD 事件发生率为 7.5%对应的边界。它还通过纳入来自另一队列的个体患者的荟萃分析结果来评估他汀类药物适应证的重新分类。
结果
本研究纳入了 2 项研究（2295 例患者；66%为男性；非阻塞性 CAD 的患病率为 47%；中位随访时间为 49 个月；67 例 ASCVD 事件）。非阻塞性 CAD 对 ASCVD 事件的 hazard ratio 为 3.2（95%置信区间：1.5 至 6.7）。将此信息纳入 pooled cohort equation 中，导致在非阻塞性 CAD 患者中他汀类药物适应证的重新分类，在非裔美国女性和男性中，原始 ASCVD 评分分别为 3.0%和 5.9%或更高，在白种女性和男性中，评分分别为 4.4%和 4.6%或更高。如果非阻塞性 CAD 不存在，并且原始 ASCVD 评分分别为非裔美国女性和男性的 10.0%和 17.9%或更低，以及白种女性和男性的 13.7%和 14.3%或更低，则他汀类药物适应证重新分类为不合格。
结论
冠状动脉 CT 血管造影术（CCTA）检测到非阻塞性 CAD 可改善风险分层，并允许根据性别和种族群体进行个体化和更恰当的他汀类药物治疗分配。
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