MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Városmajor st, 1122 Budapest, Hungary.
Medical Imaging Centre, Semmelweis University, 2 Korányi Sándor st, 1083 Budapest, Hungary.
Eur Heart J Cardiovasc Imaging. 2022 Oct 20;23(11):1530-1539. doi: 10.1093/ehjci/jeab215.
We wished to assess whether different clinical definitions of coronary artery disease (CAD) [segment stenosis and involvement score (SSS, SIS), Coronary Artery Disease-Reporting and Data System (CAD-RADS)] affect which patients are considered to progress and which risk factors affect progression.
We enrolled 115 subsequent patients (60.1 ± 9.6 years, 27% female) who underwent serial coronary computed tomography angiography (CTA) imaging with >1year between the two examinations. CAD was described using SSS, SIS, and CAD-RADS. Linear mixed models were used to investigate the effects of risk factors on the overall amount of CAD and the effect on annual progression rate of different definitions. Coronary plaque burdens were SSS 4.63 ± 4.06 vs. 5.67 ± 5.10, P < 0.001; SIS 3.43 ± 2.53 vs. 3.89 ± 2.65, P < 0.001; CAD-RADS 0:8.7% vs. 0.0% 1:44.3% vs. 40.9%, 2:34.8% vs. 40.9%, 3:7.0% vs. 9.6% 4:3.5% vs. 6.1% 5:1.7% vs. 2.6%, P < 0.001, at baseline and follow-up, respectively. Overall, 53.0%, 29.6%, and 28.7% of patients progressed over time based on SSS, SIS, and CAD-RADS, respectively. Of the patients who progressed based on SSS, only 54% showed changes in CAD-RADS. Smoking and diabetes increased the annual progression rate of SSS by 0.37/year and 0.38/year, respectively (both P < 0.05). Furthermore, each year increase in age raised SSS by 0.12 [confidence interval (CI) 0.05-0.20, P = 0.001] and SIS 0.10 (CI 0.06-0.15, P < 0.001), while female sex was associated with 2.86 lower SSS (CI -4.52 to -1.20, P < 0.001) and 1.68 SIS values (CI -2.65 to -0.77, P = 0.001).
CAD-RADS could not capture the progression of CAD in almost half of patients with serial CTA. Differences in CAD definitions may lead to significant differences in patients who are considered to progress, and which risk factors are considered to influence progression.
我们希望评估不同的冠状动脉疾病（CAD）临床定义[节段狭窄和受累评分（SSS、SIS）、冠状动脉疾病报告和数据系统（CAD-RADS）]是否会影响哪些患者被认为会进展，以及哪些危险因素会影响进展。
我们招募了 115 名连续接受冠状动脉计算机断层扫描血管造影（CTA）成像的后续患者（60.1±9.6 岁，27%为女性），两次检查之间间隔>1 年。使用 SSS、SIS 和 CAD-RADS 描述 CAD。线性混合模型用于研究危险因素对总体 CAD 量的影响以及不同定义对年度进展率的影响。冠状动脉斑块负担为 SSS 4.63±4.06 比 5.67±5.10，P<0.001；SIS 3.43±2.53 比 3.89±2.65，P<0.001；CAD-RADS 0：8.7%比 0.0%，1：44.3%比 40.9%，2：34.8%比 40.9%，3：7.0%比 9.6%，4：3.5%比 6.1%，5：1.7%比 2.6%，P<0.001，分别在基线和随访时。总体而言，基于 SSS、SIS 和 CAD-RADS，分别有 53.0%、29.6%和 28.7%的患者随时间进展。基于 SSS 进展的患者中，只有 54%的患者 CAD-RADS 发生变化。吸烟和糖尿病使 SSS 的年度进展率分别增加了 0.37/年和 0.38/年（均 P<0.05）。此外，年龄每年增加 0.12[置信区间（CI）0.05-0.20，P=0.001]和 SIS 0.10（CI 0.06-0.15，P<0.001），而女性与 SSS 降低 2.86[CI-4.52 至-1.20，P<0.001]和 SIS 降低 1.68 有关[CI-2.65 至-0.77，P=0.001]。
CAD-RADS 无法捕捉到连续 CTA 中近一半 CAD 患者的进展。CAD 定义的差异可能导致被认为会进展的患者以及被认为会影响进展的危险因素存在显著差异。
