基于计算机断层扫描冠状动脉造影的中长期随访：定量斑块特征及其与急性冠状动脉综合征的关联
Quantitative plaque characterisation and association with acute coronary syndrome on medium to long term follow up: insights from computed tomography coronary angiography.
作者信息
Munnur Ravi K, Cheng Kevin, Laggoune Jordan, Talman Andrew, Muthalaly Rahul, Nerlekar Nitesh, Baey Yi-Wei, Nogic Jason, Lin Andrew, Cameron James D, Seneviratne Sujith, Wong Dennis T L
机构信息
Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, Clayton, VIC, Australia.
South Australian Health Medical Research Institute (SAHMRI), Adelaide, Australia.
出版信息
Cardiovasc Diagn Ther. 2022 Aug;12(4):415-425. doi: 10.21037/cdt-21-763.
BACKGROUND
Computed tomography coronary angiography (CTCA) is an established imaging modality widely used for diagnosing coronary artery stenosis with expanding potential for comprehensive assessment of coronary artery disease (CAD). Lesion-based analyses of high-risk plaques (HRP) on CTCA may aid further in prognostication presenting with stable chest pain. We conduct qualitative and quantitative assessments to identify HRPs that are associated with acute coronary syndrome (ACS) on a medium to long term follow-up.
METHODS
Retrospective cohort study of patients who underwent CTCA for suspected CAD. Obstructive stenosis (OS) is defined as ≥50% and the presence of HRP and its constituents: positive-remodelling (PR), low-attenuation-plaque (LAP; <56 HU), very-low-attenuation-plaque (vLAP; <30 HU) and spotty-calcification (SC) were recorded. A cross-sectional quantitative analysis of HRP was performed at the site of minimum-luminal-area (MLA). The primary endpoint was fatal or non-fatal ACS on follow-up.
RESULTS
A total of 1,257 patients were included (mean age 61±14 years old and 51% male) with a median follow-up of 7.24 years (interquartile range 5.5 to 7.7 years). The occurrence of ACS was significantly higher in HRP (+) patients compared to HRP (-) patients and patients with no plaques (20.5% 1.6% 0.4%, log-rank test P<0.001). ACS was more frequent in HRP (+)/OS (+) patients (20.7%) compared to HRP (+)/OS (-) patients (8.6%), HRP (-)/OS (+) patients (1.8%) and HRP (-)/OS (-) patients (1.0%). OS, cross-sectional plaque area (PA) and the presence of vLAP identified those HRP lesions that were more likely to cause future ACS. Cross-sectional LAP area (<56 HU) in HRP lesions added incremental prognostic value to OS in predicting ACS (P=0.008).
CONCLUSIONS
The presence of OS and the LAP area at the site of MLA identify the HRP lesions that have the greatest association with development of future ACS.
背景
计算机断层扫描冠状动脉造影（CTCA）是一种成熟的成像方式，广泛用于诊断冠状动脉狭窄，在全面评估冠状动脉疾病（CAD）方面具有不断扩大的潜力。基于CTCA对高危斑块（HRP）进行基于病变的分析可能有助于对表现为稳定胸痛的患者进行进一步的预后评估。我们进行定性和定量评估，以确定在中长期随访中与急性冠状动脉综合征（ACS）相关的HRP。
方法
对因疑似CAD接受CTCA的患者进行回顾性队列研究。阻塞性狭窄（OS）定义为≥50%，记录HRP及其成分的存在情况：阳性重塑（PR）、低密度斑块（LAP；<56 HU）、极低密度斑块（vLAP；<30 HU）和斑点状钙化（SC）。在最小管腔面积（MLA）部位对HRP进行横断面定量分析。主要终点是随访期间的致命或非致命ACS。
结果
共纳入1257例患者（平均年龄61±14岁，51%为男性），中位随访时间为7.24年（四分位间距5.5至7.7年）。与HRP（-）患者和无斑块患者相比，HRP（+）患者中ACS的发生率显著更高（20.5%对1.6%对0.4%，对数秩检验P<0.001）。与HRP（+）/OS（-）患者（8.6%）、HRP（-）/OS（+）患者（1.8%）和HRP（-）/OS（-）患者（1.0%）相比，HRP（+）/OS（+）患者中ACS更常见（20.7%）。OS、横断面斑块面积（PA）和vLAP的存在确定了那些更有可能导致未来ACS的HRP病变。HRP病变中的横断面LAP面积（<56 HU）在预测ACS时为OS增加了额外的预后价值（P=0.008）。
结论
OS的存在以及MLA部位的LAP面积确定了与未来ACS发生最相关联的HRP病变。
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