Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and Weill Cornell Medicine, 413 East 69th Street, Suite 108, New York, NY 10021, USA.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Eur Heart J Cardiovasc Imaging. 2022 Oct 20;23(11):1482-1491. doi: 10.1093/ehjci/jeac044.
Atherosclerosis develops progressively and worsens over time, yet event risk patterns vary in the left circumflex (LCx), right coronary artery (RCA) and left anterior descending (LAD). The aim of this analysis was to examine varying progressive disease alterations between the three major coronary arteries.
Patients were included from a prospective, international registry of consecutive patients who underwent serial CCTA at a median interval of 3.3 years. Annual progression of quantitative total and compositional plaque volume were compared between the three coronary arteries (LCx, LAD, and RCA). Other analyses compared stenosis ≥50% and new high-risk plaque (HRP; ≥2 of the following: spotty calcification, positive remodelling, napkin-ring sign, and low-attenuation plaque) on follow-up. Generalized estimating equations and marginal Cox regression models were used to compare progression, with covariate adjustment by the baseline atherosclerotic cardiovascular disease risk score, statin use, and plaque burden. Quantitative plaque measurements were calculated in 1344 patients (age 60 ± 9 years, 57% men). Plaque progression occurred less often in the LCx (41.0%) as compared to the RCA (52.7%) and LAD (77.4%, P < 0.001). Odds for annual plaque burden increase ≥population mean were 1.98- and 1.43-fold as high in the LAD (P < 0.001) and RCA (P < 0.001) as compared to the LCx. Similarly, the LAD was associated with a 2.45 higher risk of progression to obstructive CAD (P < 0.001), as compared to the LCx; with no differences between the RCA and LCx (P = 0.13). New HRP lesions formed least often in the LCx (3.4%), followed by the RCA (8.1%) and most often in the LAD (10.1%; P < 0.001).
Our findings reveal novel insights into varied patterns of atherosclerotic plaque progression within the LCx as compared to the other epicardial coronary arteries. These varied patterns reflect differing stages in the disease process or differing pathogenic milieu across the coronary arteries.
动脉粥样硬化是一种进行性疾病，随着时间的推移会逐渐恶化，但在左回旋支（LCx）、右冠状动脉（RCA）和左前降支（LAD）中的病变事件风险模式不同。本分析的目的是检查三种主要冠状动脉之间不同的进行性疾病变化。
本研究纳入了一项前瞻性、国际连续患者注册研究，这些患者在中位数为 3.3 年的时间内接受了连续 CCTA。比较了三种冠状动脉（LCx、LAD 和 RCA）之间定量总斑块体积和成分斑块体积的年度进展。其他分析比较了随访时狭窄≥50%和新的高危斑块（HRP；以下任何两种情况：点状钙化、正性重构、餐巾环征和低衰减斑块）。采用广义估计方程和边缘 Cox 回归模型比较进展情况，采用基线动脉粥样硬化性心血管疾病风险评分、他汀类药物使用和斑块负担进行协变量调整。对 1344 例患者（年龄 60±9 岁，57%为男性）进行了定量斑块测量。与 RCA（52.7%）和 LAD（77.4%，P＜0.001）相比，LCx 中斑块进展发生较少（41.0%）。LAD（P＜0.001）和 RCA（P＜0.001）的斑块负担年增长率≥人群平均值的可能性分别为 LCx 的 1.98 倍和 1.43 倍。同样，与 LCx 相比，LAD 进展为阻塞性 CAD 的风险增加 2.45 倍（P＜0.001），而 RCA 与 LCx 之间无差异（P=0.13）。LCx 中形成新的 HRP 病变的比例最低（3.4%），其次是 RCA（8.1%），LAD 中形成新的 HRP 病变的比例最高（10.1%；P＜0.001）。
与其他心外膜冠状动脉相比，我们的研究结果揭示了 LCx 内动脉粥样硬化斑块进展模式的新见解。这些不同的模式反映了疾病过程的不同阶段或不同的冠状动脉致病环境。
