Chinese PLA Medical College & Department of Cardiology, National Clinic Research Center Geriatric Disease, 2nd Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
Department of Radiology, 2nd Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
Eur Radiol. 2022 Jul;32(7):4374-4383. doi: 10.1007/s00330-022-08594-w. Epub 2022 Feb 28.
OBJECTIVES: To investigate the long-term effects of intensive LDL cholesterol-lowering treatments on lumen stenosis severity, plaque calcification, spotty calcifications, percent calcified plaque volume (PCPV), and Agatston coronary artery calcium score (CACS) based on coronary computed tomography angiography (CCTA) in elderly patients. METHODS: A total of 240 patients over 60 years old (comprising 754 lesions) who underwent serial CCTA were retrospectively enrolled in this 5-year cohort study. Patients were divided into three groups: an intensive lipid-lowering group, a lipid-lowering group, and a control group. The stenosis severity, plaque volume (PV), plaque composition, PCPV, and high-risk plaque (HRP) presence were quantitatively analyzed. The CACS was calculated at baseline and follow-up. RESULTS: All patients were male with an average age of 66.8 ± 5.8 years old. Over time, increases in the percentages of obstructive coronary lesions (p < 0.001) were observed. Compared with those at baseline, the percentage of obstructive lesions remained unchanged (p = 0.077), and the percentage of spotty calcifications significantly decreased (p < 0.05) at the follow-up CCTA scan in the intensive lipid-lowering group. Patients in the intensive lipid-lowering group demonstrated a higher progression in calcified PV, CACS, and PCPV (all p < 0.05), and a significantly greater attenuation in fibrous-fatty and lipid-rich PV (all p < 0.05) than patients in other groups. CONCLUSIONS: The PV and contents increased gradually with time in all groups. Intensive LDL-C lowering was associated with slower progression of stenosis severity and reduction of high-risk plaque features, with increased plaque calcification and higher progression in PCPV. Comprehensive serial plaque evaluations by CCTAs may contribute to further refinement of risk stratification and reasonable lipid-lowering treatment in elderly patients. KEY POINTS: • Intensive LDL-C lowering increased coronary calcification and percent calcified plaque volume progression. • Comprehensive serial plaque evaluations by serial CCTAs may help to refine risk stratification.
目的：通过冠状动脉计算机断层扫描血管造影术（CCTA），研究强化 LDL 胆固醇降低治疗对老年患者管腔狭窄严重程度、斑块钙化、点状钙化、斑块钙化体积百分比（PCPV）和冠状动脉钙化积分（CACS）的长期影响。
方法：回顾性纳入了 240 名年龄超过 60 岁（包含 754 个病变）并接受连续 CCTA 检查的患者，进行了这项为期 5 年的队列研究。患者分为三组：强化降脂组、降脂组和对照组。定量分析了狭窄严重程度、斑块体积（PV）、斑块成分、PCPV 和高危斑块（HRP）的存在。在基线和随访时计算 CACS。
结果：所有患者均为男性，平均年龄为 66.8 ± 5.8 岁。随着时间的推移，阻塞性冠状动脉病变的百分比增加（p<0.001）。与基线相比，强化降脂组在随访 CCTA 扫描时，阻塞性病变的百分比保持不变（p=0.077），而点状钙化的百分比显著降低（p<0.05）。强化降脂组的钙化 PV、CACS 和 PCPV 均呈逐渐进展趋势（均 p<0.05），而纤维脂肪和富含脂质的 PV 则呈逐渐减少趋势（均 p<0.05）。
结论：所有组的 PV 和含量随时间逐渐增加。强化 LDL-C 降低与狭窄严重程度的进展缓慢和高危斑块特征的减少相关，斑块钙化增加，PCPV 进展更快。通过连续 CCTA 进行综合的斑块评估可能有助于进一步细化风险分层和老年患者的合理降脂治疗。
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