Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.
Department of Medicine, University of Erlangen, Erlangen, Germany.
Atherosclerosis. 2020 Sep;309:33-38. doi: 10.1016/j.atherosclerosis.2020.07.011. Epub 2020 Jul 29.
The Agatston coronary artery calcium score (CACS) may fail to identify small or less dense coronary calcification that can be detected on coronary CT angiography (CCTA). We investigated the prevalence and prognostic importance of subtle calcified plaques on CCTA among individuals with CACS 0.
From the prospective multicenter CONFIRM registry, we evaluated patients without known CAD who underwent CAC scan and CCTA. CACS was categorized as 0, 1-10, 11-100, 101-400, and >400. Patients with CACS 0 were stratified according to the visual presence of coronary plaques on CCTA. Plaque composition was categorized as non-calcified (NCP), mixed (MP) and calcified (CP). The primary outcome was a major adverse cardiac event (MACE) which was defined as death and myocardial infarction.
Of 4049 patients, 1741 (43%) had a CACS 0. NCP and plaques that contained calcium (MP or CP) were detected by CCTA in 110 patients (6% of CACS 0) and 64 patients (4% of CACS 0), respectively. During a 5.6 years median follow-up (IQR 5.1-6.2 years), 413 MACE events occurred (13%). Patients with CACS 0 and MP/CP detected by CCTA had similar MACE risk compared to patients with CACS 1-10 (p = 0.868). In patients with CACS 0, after adjustment for risk factors and symptom, MP/CP was associated with an increased MACE risk compared to those with entirely normal CCTA (HR 2.39, 95% CI [1.09-5.24], p = 0.030).
A small but non-negligible proportion of patients with CACS 0 had identifiable coronary calcification, which was associated with increased MACE risk. Modifying CAC image acquisition and/or scoring methods could improve the detection of subtle coronary calcification.
Agatston 冠状动脉钙评分（CACS）可能无法识别在冠状动脉 CT 血管造影（CCTA）上可检测到的小或密度较低的冠状动脉钙化。我们研究了在 CACS 为 0 的人群中，CCTA 上细微钙化斑块的患病率和预后重要性。
我们从前瞻性多中心 CONFIRM 注册中心评估了接受 CAC 扫描和 CCTA 的无已知 CAD 的患者。将 CACS 分为 0、1-10、11-100、101-400 和>400。根据 CCTA 上冠状动脉斑块的视觉存在将 CACS 为 0 的患者分层。斑块成分分为非钙化（NCP）、混合（MP）和钙化（CP）。主要结局是主要不良心脏事件（MACE），定义为死亡和心肌梗死。
在 4049 例患者中，有 1741 例（43%）的 CACS 为 0。NCP 和含有钙的斑块（MP 或 CP）在 110 例（CACS 0 的 6%）和 64 例（CACS 0 的 4%）患者中通过 CCTA 检测到。在中位数为 5.6 年的中位随访期间（IQR 5.1-6.2 年），发生了 413 例 MACE 事件（13%）。与 CACS 1-10 患者相比，CACS 0 且 CCTA 检测到 MP/CP 的患者的 MACE 风险相似（p=0.868）。在 CACS 0 的患者中，在校正危险因素和症状后，与 CCTA 完全正常的患者相比，MP/CP 与 MACE 风险增加相关（HR 2.39，95%CI[1.09-5.24]，p=0.030）。
一小部分但不可忽视的 CACS 0 患者存在可识别的冠状动脉钙化，这与 MACE 风险增加相关。改变 CAC 图像采集和/或评分方法可能会提高对细微冠状动脉钙化的检测。
