Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea.
Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
Int J Cardiovasc Imaging. 2020 Dec;36(12):2357-2364. doi: 10.1007/s10554-020-01960-z. Epub 2020 Aug 10.
To determine whether the assessment of individual plaques is superior in predicting the progression to obstructive coronary artery disease (CAD) on serial coronary computed tomography angiography (CCTA) than per-patient assessment. From a multinational registry of 2252 patients who underwent serial CCTA at a ≥ 2-year inter-scan interval, patients with only non-obstructive lesions at baseline were enrolled. CCTA was quantitatively analyzed at both the per-patient and per-lesion level. Models predicting the development of an obstructive lesion at follow up using either the per-patient or per-lesion level CCTA measures were constructed and compared. From 1297 patients (mean age 60 ± 9 years, 43% men) enrolled, a total of 3218 non-obstructive lesions were identified at baseline. At follow-up (inter-scan interval: 3.8 ± 1.6 years), 76 lesions (2.4%, 60 patients) became obstructive, defined as > 50% diameter stenosis. The C-statistics of Model 1, adjusted only by clinical risk factors, was 0.684. The addition of per-patient level total plaque volume (PV) and the presence of high-risk plaque (HRP) features to Model 1 improved the C-statistics to 0.825 [95% confidence interval (CI) 0.823-0.827]. When per-lesion level PV and the presence of HRP were added to Model 1, the predictive value of the model improved the C-statistics to 0.895 [95% CI 0.893-0.897]. The model utilizing per-lesion level CCTA measures was superior to the model utilizing per-patient level CCTA measures in predicting the development of an obstructive lesion (p < 0.001). Lesion-level analysis of coronary atherosclerotic plaques with CCTA yielded better predictive power for the development of obstructive CAD than the simple quantification of total coronary atherosclerotic burden at a per-patient level.Clinical Trial Registration: ClinicalTrials.gov NCT0280341.
为了确定在连续冠状动脉计算机断层扫描血管造影（CCTA）中，个体斑块的评估是否优于每例患者评估，从而预测进展为阻塞性冠状动脉疾病（CAD）。该研究来自于一项多国注册研究，共纳入 2252 名在至少 2 年的扫描间隔内接受连续 CCTA 的患者，这些患者在基线时仅存在非阻塞性病变。对每例患者和每例病变水平的 CCTA 进行定量分析。构建并比较了使用每例患者或每例病变水平 CCTA 测量值预测随访时出现阻塞性病变的模型。从 1297 名（平均年龄 60±9 岁，43%为男性）入选患者中，基线时共确定 3218 个非阻塞性病变。在随访（扫描间隔：3.8±1.6 年）期间，76 个病变（2.4%，60 例患者）进展为阻塞性病变，定义为>50%的直径狭窄。仅调整临床危险因素的模型 1 的 C 统计量为 0.684。将每例患者水平总斑块体积（PV）和高危斑块（HRP）特征添加到模型 1 中，将 C 统计量提高到 0.825[95%置信区间（CI）0.823-0.827]。当将每例病变水平 PV 和 HRP 存在添加到模型 1 中时，模型的预测价值提高了 C 统计量至 0.895[95%CI 0.893-0.897]。与使用每例患者水平 CCTA 测量值的模型相比，使用每例病变水平 CCTA 测量值的模型在预测阻塞性病变的发展方面具有更好的预测价值（p<0.001）。与每例患者水平的冠状动脉粥样硬化总负荷的简单定量相比，CCTA 对冠状动脉粥样硬化斑块的病变水平分析可为阻塞性 CAD 的发展提供更好的预测能力。
ClinicalTrials.gov NCT0280341。
