冠状动脉狭窄与动脉粥样硬化斑块负荷评估对预测 30 天血运重建和 2 年主要不良心脏事件的比较效果。
Comparative effectiveness of coronary artery stenosis and atherosclerotic plaque burden assessment for predicting 30-day revascularization and 2-year major adverse cardiac events.
机构信息
Department of Medicine/ Diabetology, Mitsui Memorial Hospital, Tokyo, Japan.
Federal University of Paraná, Hospital de Clínicas (CHC-UFPR), Curitiba, Brazil.
出版信息
Int J Cardiovasc Imaging. 2020 Dec;36(12):2365-2375. doi: 10.1007/s10554-020-01851-3. Epub 2020 May 2.
PURPOSE
To provide comparative prognostic information of coronary atherosclerotic plaque volume and stenosis assessment in patients with suspected coronary artery disease (CAD).
METHODS
We followed 372 patients with suspected or known CAD enrolled in the CORE320 study for 2 years after baseline 320-detector row cardiac CT scanning and invasive quantitative coronary angiography (QCA). CT images were analyzed for coronary calcium scanning (CACS), semi-automatically derived total percent atheroma volume (PAV), segment stenosis score (SSS), in addition to traditional stenosis assessment (≥ 50%) by CT and QCA for (1) 30-day revascularization and (2) major adverse cardiac events (MACE). Area under the receiver operating characteristic curve (AUC) was used to compare accuracy of risk prediction.
RESULTS
Sixty percent of patients had obstructive CAD by QCA with 23% undergoing 30-day revascularization and 9% experiencing MACE at 2 years. Most late events (20/32) were revascularization procedures. Prediction of 30-day revascularization was modest (AUC range 0.67-0.78) but improved after excluding patients with known CAD (AUC range 0.73-0.86, p < 0.05 for all). Similarly, prediction of MACE improved after excluding patients with known CAD (AUC range 0.58-0.73 vs. 0.63-0.77). CT metrics of atherosclerosis burden performed overall similarly but stenosis assessment was superior for predicting 30-day revascularization.
CONCLUSIONS
Angiographic and coronary atherosclerotic plaque metrics perform only modestly well for predicting 30-day revascularization and 2-year MACE in high risk patients but improve after excluding patients with known CAD. Atherosclerotic plaque metrics did not yield incremental value over stenosis assessment for predicting events that predominantly consisted of revascularization procedures.
CLINICAL TRIAL REGISTRATION
NCT00934037.
目的
为疑似冠心病（CAD）患者提供冠状动脉粥样硬化斑块体积和狭窄评估的预后比较信息。
方法
我们对在基线 320 排心脏 CT 扫描和有创定量冠状动脉造影（QCA）后 2 年内发生疑似或已知 CAD 的 372 例患者进行了随访。对 CT 图像进行冠状动脉钙扫描（CACS）、半自动得出的总动脉粥样硬化斑块体积（PAV）、节段狭窄评分（SSS）分析，以及 CT 和 QCA 进行的传统狭窄评估（≥50%），用于（1）30 天血运重建和（2）主要不良心脏事件（MACE）。采用受试者工作特征曲线下面积（AUC）比较风险预测的准确性。
结果
QCA 显示 60%的患者存在阻塞性 CAD，其中 23%在 30 天内行血运重建，9%在 2 年内发生 MACE。大多数晚期事件（20/32）为血运重建术。30 天血运重建的预测能力一般（AUC 范围 0.67-0.78），但排除已知 CAD 患者后有所提高（AUC 范围 0.73-0.86，p<0.05）。同样，排除已知 CAD 患者后，MACE 的预测也有所改善（AUC 范围 0.58-0.73 与 0.63-0.77）。动脉粥样硬化负担的 CT 指标总体上表现相似，但狭窄评估对预测 30 天血运重建的效果更好。
结论
在高危患者中，血管造影和冠状动脉粥样硬化斑块指标对预测 30 天血运重建和 2 年 MACE 的效果仅为中等，但排除已知 CAD 患者后会有所改善。动脉粥样硬化斑块指标在预测主要由血运重建术组成的事件时，并未优于狭窄评估。
临床试验注册号
NCT00934037。
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