Centro Cardiologico Monzino, Institute for Research, Hospitalization and Health Care, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
Heart Care Foundation Onlus, Florence, Italy.
JACC Cardiovasc Imaging. 2020 Aug;13(8):1704-1717. doi: 10.1016/j.jcmg.2019.06.019. Epub 2019 Aug 14.
This study sought to assess whether coronary atherosclerosis analysis by coronary computed tomography angiography (CTA) may improve prognostic stratification among patients with diffuse coronary artery disease (CAD) BACKGROUND: Coronary CTA has recently emerged as a promising noninvasive tool for advanced analysis of coronary atherosclerosis.
The multicenter CAPIRE (Coronary Atherosclerosis in outlier subjects: Protective and novel Individual Risk factors Evaluation) study is part of the GISSI Outlier Project. A prospective cohort of subjects who underwent coronary CTA for suspected CAD was enrolled. Based on risk factor (RF) burden, patients were defined as having a low clinical risk (0 to 1 RF with the exclusion of patients with diabetes mellitus as single RF) or at high clinical risk (3 or more RFs). Patients with 2 RFs were not enrolled in the study. Coronary CTA advanced plaque assessment was performed. Outcome measures were 3 combined endpoints: acute coronary syndrome (ACS), cardiac death + ACS, and cardiac death + ACS + late revascularization.
Among the 544 patients enrolled in the CAPIRE study, in 522 patients, a mean follow-up of 37 ± 10 months was obtained (16 patients were excluded due to 1 < segment involvement score <5 at core lab coronary CTA analysis and 6 patients were lost at follow-up). Higher atherosclerotic burden was found in patients with higher clinical risk, but prevalence of elevated noncalcified plaque volume did not significantly differ between low- versus high-risk patients. Quantitative plaque parameters by coronary CTA were associated with composite endpoints at multivariable analysis when corrected for univariate predictors. Elevated noncalcified plaque volume, expressed as dichotomic variable, was associated with all combined endpoints. Even if the low absolute number of events represents a limitation to the present study, patients with low noncalcified plaque volume had similar risk of cardiac events independently from the presence of multivessel disease, while patients with high noncalcified plaque volume had higher rates of cardiac events.
The CAPIRE study confirmed the prognostic value of atherosclerosis assessment by coronary CTA, demonstrating high noncalcified plaque volume as the most ACS-predictive parameter in patients with extensive CAD. (GISSE Outliers CAPIRE [CAPIRE]; NCT02157662).
本研究旨在评估冠状动脉计算机断层血管造影（CTA）分析是否可以改善弥漫性冠状动脉疾病（CAD）患者的预后分层。
冠状动脉 CTA 最近已成为一种有前途的冠状动脉粥样硬化高级分析的非侵入性工具。
多中心 CAPIRE（冠状动脉粥样硬化在异常值患者中的作用：保护和新型个体危险因素评估）研究是 GISSI 异常值项目的一部分。一项疑似 CAD 患者接受冠状动脉 CTA 的前瞻性队列研究纳入了该研究。基于危险因素（RF）负担，患者被定义为低临床风险（0 至 1 RF，不包括单独 RF 为糖尿病的患者）或高临床风险（3 个或更多 RF）。未纳入具有 2 个 RF 的患者。进行了冠状动脉 CTA 高级斑块评估。主要终点是 3 个联合终点：急性冠状动脉综合征（ACS）、心脏死亡+ACS 和心脏死亡+ACS+晚期血运重建。
在 CAPIRE 研究中，544 名患者中有 522 名患者获得了 37±10 个月的平均随访时间（由于核心实验室冠状动脉 CTA 分析中 1<节段受累评分<5 排除了 16 名患者，有 6 名患者在随访时丢失）。在临床风险较高的患者中发现了更高的动脉粥样硬化负担，但低危患者和高危患者之间的非钙化斑块体积升高的发生率没有显著差异。多变量分析校正单变量预测因子后，冠状动脉 CTA 的定量斑块参数与复合终点相关。非钙化斑块体积升高（表示为二分变量）与所有复合终点相关。尽管低事件绝对数限制了本研究，但低非钙化斑块体积患者的心脏事件风险相似，独立于多血管疾病的存在，而高非钙化斑块体积患者的心脏事件发生率更高。
CAPIRE 研究证实了冠状动脉 CTA 评估动脉粥样硬化的预后价值，表明高非钙化斑块体积是广泛 CAD 患者中预测 ACS 的最有价值参数。（GISSE 异常值 CAPIRE[CAPIRE]；NCT02157662）。
