Arrey-Mbi Takor B, Klusewitz Seth M, Villines Todd C
Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, 8930 Brown Drive, Bld 9A, Room 2335, Bethesda, MD, 20889, USA.
Curr Treat Options Cardiovasc Med. 2017 Oct 12;19(12):90. doi: 10.1007/s11936-017-0588-5.
Coronary CT angiography (CTA) is a highly accurate test for the diagnosis of coronary artery disease (CAD), with its use guided by numerous contemporary appropriate use criteria and clinical guidelines. Unique among non-invasive tests for CAD, coronary CTA provides direct visualization of coronary atherosclerosis for the assessment of angiographic stenosis, as well as validated measures of plaque vulnerability. Long-term studies now clearly demonstrate that the absence of CAD on coronary CTA identifies a patient that is at very low risk for future cardiovascular events. Conversely, the presence, location, and severity of CAD as measured on coronary CTA provide powerful prognostic information that is superior to traditional risk factors and other clinical variables. Observational studies and data obtained from clinical trials suggest that the anatomic information derived from coronary CTA significantly increases the utilization of statins and aspirin. Furthermore, these changes are associated with reductions in the risk for mortality, revascularizations, and incident myocardial infarctions among subjects with coronary atherosclerosis. As a result, current societal consensus statements have attempted to standardize coronary CTA reporting, to include incorporation of vulnerable plaque features and recommendations on the use of preventive therapies, such as statins, so to more consistently link important prognostic findings on coronary CTA to appropriate preventive and therapeutic interventions. Automated measures of total coronary plaque volume, machine learning, and CT-derived fractional flow reserve may further refine the prognostic accuracy of coronary CTA. Herein, we summarize recently published literature that reports the long-term (≥ 5 years of follow-up) prognostic usefulness of coronary CTA.
冠状动脉CT血管造影（CTA）是诊断冠状动脉疾病（CAD）的一种高度准确的检查方法，其应用遵循众多当代适用标准和临床指南。在CAD的非侵入性检查中，冠状动脉CTA独一无二，它能直接显示冠状动脉粥样硬化，用于评估血管造影狭窄情况，还能提供经过验证的斑块易损性测量方法。长期研究现已清楚表明，冠状动脉CTA显示无CAD的患者未来发生心血管事件的风险极低。相反，冠状动脉CTA测量得出的CAD的存在、位置和严重程度提供了强大的预后信息，优于传统危险因素和其他临床变量。观察性研究和从临床试验获得的数据表明，冠状动脉CTA得出的解剖学信息显著增加了他汀类药物和阿司匹林的使用。此外，这些变化与冠状动脉粥样硬化患者的死亡率、血运重建和心肌梗死发生率降低相关。因此，当前的社会共识声明试图规范冠状动脉CTA报告，包括纳入易损斑块特征以及关于使用他汀类药物等预防性治疗的建议，以便更一致地将冠状动脉CTA上重要的预后发现与适当的预防和治疗干预联系起来。冠状动脉总斑块体积的自动测量、机器学习和CT衍生的血流储备分数可能会进一步提高冠状动脉CTA的预后准确性。在此，我们总结最近发表的文献，这些文献报告了冠状动脉CTA的长期（≥5年随访）预后效用。
