Department of Cardiology, Leiden University Medical Center, The Netherlands (J.M.S., A.R.v.R., M.E.M., A.J.S.).
Fondazione Toscana Gabriele Monasterio, Pisa, Italy (D.N.).
Circ Cardiovasc Imaging. 2020 Mar;13(3):e009750. doi: 10.1161/CIRCIMAGING.119.009750. Epub 2020 Mar 12.
Background Progression of coronary artery disease using serial coronary computed tomography angiography (CTA) is of clinical interest. Our primary aim was to prospectively assess the impact of clinical characteristics and statin use on quantitatively assessed coronary plaque progression in a low-risk study population during long-term follow-up. Methods Patients who previously underwent coronary CTA for suspected coronary artery disease were prospectively included to undergo follow-up coronary CTA. The primary end point was coronary artery disease progression, defined as the absolute annual increase in total, calcified, and noncalcified plaque volume by quantitative CTA analysis. Results In total, 202 patients underwent serial coronary CTA with a mean interscan period of 6.2±1.4 years. On a per-plaque basis, increasing age (β=0.070; =0.058) and hypertension (β=1.380; =0.075) were nonsignificantly associated with annual total plaque progression. Male sex (β=1.676; =0.009), diabetes mellitus (β=1.725; =0.012), and statin use (β=1.498; =0.046) showed an independent association with annual progression of calcified plaque. While hypertension (β=2.259; =0.015) was an independent determinant of noncalcified plaque progression, statin use (β=-2.178; =0.050) was borderline significantly associated with a reduced progression of noncalcified plaque. Conclusions Statin use was associated with an increased progression of calcified coronary plaque and a reduced progression of noncalcified coronary plaque, potentially reflecting calcification of the noncalcified plaque component. Whereas hypertension was the only modifiable risk factor predictive of noncalcified plaque progression, diabetes mellitus mainly led to an increase in calcified plaque. These findings could yield the need for intensified preventive treatment of patients with diabetes mellitus and hypertension to slow and stabilize coronary artery disease progression and improve clinical outcome.
背景 使用连续冠状动脉计算机断层扫描血管造影术（CTA）对冠状动脉疾病的进展进行评估具有临床意义。我们的主要目的是前瞻性评估临床特征和他汀类药物使用对低危研究人群在长期随访期间定量评估的冠状动脉斑块进展的影响。
方法 前瞻性纳入先前因疑似冠状动脉疾病而行冠状动脉 CTA 的患者进行随访冠状动脉 CTA。主要终点是冠状动脉疾病进展，定义为定量 CTA 分析中总、钙化和非钙化斑块体积的绝对年增长率。
结果 共有 202 例患者进行了连续冠状动脉 CTA，平均两次扫描间隔时间为 6.2±1.4 年。基于斑块的基础上，年龄的增加（β=0.070；P=0.058）和高血压（β=1.380；P=0.075）与总斑块的年进展无显著相关性。男性（β=1.676；P=0.009）、糖尿病（β=1.725；P=0.012）和他汀类药物的使用（β=1.498；P=0.046）与钙化斑块的年进展呈独立相关。而高血压（β=2.259；P=0.015）是非钙化斑块进展的独立决定因素，他汀类药物的使用（β=-2.178；P=0.050）与非钙化斑块进展呈边缘显著相关。
结论 他汀类药物的使用与钙化冠状动脉斑块的进展增加和非钙化冠状动脉斑块的进展减少相关，这可能反映了非钙化斑块成分的钙化。虽然高血压是唯一可改变的预测非钙化斑块进展的危险因素，但糖尿病主要导致钙化斑块的增加。这些发现可能需要加强对糖尿病和高血压患者的预防性治疗，以减缓和稳定冠状动脉疾病的进展并改善临床结果。
