Krohn Jona B, Nguyen Y Nhi, Akhavanpoor Mohammadreza, Erbel Christian, Domschke Gabriele, Linden Fabian, Kleber Marcus E, Delgado Graciela, März Winfried, Katus Hugo A, Gleissner Christian A
Department of Cardiology, Pulmonology and Angiology, University Hospital Heidelberg, Heidelberg, Germany.
German Centre for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany.
Front Cardiovasc Med. 2022 Mar 10;9:778206. doi: 10.3389/fcvm.2022.778206. eCollection 2022.
The roles of multiple risk factors of coronary artery disease (CAD) are well established. Commonly, CAD is considered as a single disease entity. We wish to examine whether coronary angiography allows to identify distinct CAD phenotypes associated with major risk factors and differences in prognosis.
In a cohort of 4,344 patients undergoing coronary angiography at Heidelberg University Hospital between 2014 and 2016, cluster analysis of angiographic reports identified subgroups with similar patterns of spatial distribution of high-grade stenoses. Clusters were independently confirmed in 3,129 patients from the LURIC study.
Four clusters were identified: cluster one lacking critical stenoses comprised the highest percentage of women with the lowest cardiovascular risk. Patients in cluster two exhibiting high-grade stenosis of the proximal RCA had a high prevalence of the metabolic syndrome, and showed the highest levels of inflammatory biomarkers. Cluster three with predominant proximal LAD stenosis frequently presented with acute coronary syndrome and elevated troponin levels. Cluster four with high-grade stenoses throughout had the oldest patients with the highest overall cardiovascular risk. All-cause and cardiovascular mortality differed significantly between the clusters.
We identified four phenotypic subgroups of CAD bearing distinct demographic and biochemical characteristics with differences in prognosis, which may indicate multiple disease entities currently summarized as CAD.
冠状动脉疾病（CAD）多种危险因素的作用已得到充分证实。通常，CAD被视为单一的疾病实体。我们希望研究冠状动脉造影是否能够识别与主要危险因素相关的不同CAD表型以及预后差异。
在2014年至2016年间于海德堡大学医院接受冠状动脉造影的4344例患者队列中，对血管造影报告进行聚类分析，确定了高级别狭窄空间分布模式相似的亚组。这些聚类在来自LURIC研究的3129例患者中得到独立验证。
确定了四个聚类：聚类一缺乏严重狭窄，女性比例最高，心血管风险最低。聚类二中表现为近端右冠状动脉（RCA）高级别狭窄的患者代谢综合征患病率高，炎症生物标志物水平最高。聚类三以近端左前降支（LAD）狭窄为主，常表现为急性冠状动脉综合征和肌钙蛋白水平升高。聚类四全是高级别狭窄，患者年龄最大，总体心血管风险最高。各聚类之间的全因死亡率和心血管死亡率有显著差异。
我们识别出CAD的四个表型亚组，它们具有不同的人口统计学和生化特征，预后存在差异，这可能表明目前概括为CAD的是多种疾病实体。
