Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany.
Eur Radiol. 2023 Jul;33(7):4657-4667. doi: 10.1007/s00330-023-09430-5. Epub 2023 Jan 31.
To compare the prognostic value of individual CT-derived coronary artery disease (CAD) characteristics across categories of clinical cardiovascular risk.
The central core laboratory assessed coronary artery calcium (CAC), obstructive CAD (stenosis ≥ 50%), and high-risk plaque (HRP) in stable outpatients with suspected CAD enrolled in the PROMISE trial. Multivariable Cox regression models (endpoint: unstable angina, nonfatal myocardial infarction, or all-cause mortality; median follow-up: 2 years) were used to compare hazard ratios (HR) of the CT measures between low-borderline (< 7.5%) and moderate-high (≥ 7.5%) atherosclerotic cardiovascular disease (ASCVD) risk based on the pooled cohort equation.
Among 4356 included patients (aged 61 ± 8 years, 52% women), 67% had ASCVD risk ≥ 7.5%. Stratified by ASCVD risk, CAD ≥ 50% had nearly threefold greater HR in individuals with ASCVD < 7.5% (aHR, 6.85; 95% CI, 2.33-20.15; p < 0.001) vs. ASCVD ≥ 7.5% (aHR: 2.66, 95% CI: 1.67-4.25, p < 0.001; interaction p = 0.041). CAC predicted events solely in ASCVD ≥ 7.5% patients (aHR: 1.92, 95% CI: 1.01-3.63, p = 0.045; interaction p = 0.571), while HRP predicted events only in ASCVD < 7.5% (aHR: 3.11, 95% CI: 1.09-8.85, p = 0.034; interaction p = 0.034).
Prognostic values of CT-derived CAD characteristics differ by ASCVD risk categories. While CAD ≥ 50% has the highest prognostic value regardless of ASCVD risk, CAC is prognostic in high and HRP in low ASCVD risk. These findings suggest that CAD ≥ 50% and HRP detection rather than CAC scoring may better risk-stratify symptomatic low-risk patients and thus potentially improve downstream care.
• Prognostic value of individual CT-derived CAD characteristics differs by categories of cardiovascular risk. • Presence of obstructive coronary artery stenosis ≥ 50% has the highest prognostic value regardless of cardiovascular risk. • Coronary artery calcium is independently prognostic in high and high-risk plaque features in low cardiovascular risk.
比较不同临床心血管风险类别中个体 CT 衍生的冠状动脉疾病（CAD）特征的预后价值。
核心实验室评估了疑似 CAD 稳定门诊患者的冠状动脉钙（CAC）、阻塞性 CAD（狭窄≥50%）和高危斑块（HRP）。多变量 Cox 回归模型（终点：不稳定型心绞痛、非致死性心肌梗死或全因死亡率；中位随访：2 年）用于比较基于汇总队列方程的低边界（<7.5%）和中高（≥7.5%）动脉粥样硬化性心血管疾病（ASCVD）风险的 CT 测量值的危险比（HR）。
在纳入的 4356 例患者（年龄 61±8 岁，52%为女性）中，67%的患者 ASCVD 风险≥7.5%。按 ASCVD 风险分层，在 ASCVD<7.5%的患者中，CAD≥50%的 HR 几乎高出三倍（aHR，6.85；95%CI，2.33-20.15；p<0.001），而 ASCVD≥7.5%的患者（aHR：2.66，95%CI：1.67-4.25，p<0.001；交互 p=0.041）。CAC 仅在 ASCVD≥7.5%的患者中预测事件（aHR：1.92，95%CI：1.01-3.63，p=0.045；交互 p=0.571），而 HRP 仅在 ASCVD<7.5%的患者中预测事件（aHR：3.11，95%CI：1.09-8.85，p=0.034；交互 p=0.034）。
CT 衍生的 CAD 特征的预后价值因 ASCVD 风险类别而异。虽然 CAD≥50%无论 ASCVD 风险如何都具有最高的预后价值，但 CAC 在高风险和 HRP 在低 ASCVD 风险中具有预后价值。这些发现表明，CAD≥50%和 HRP 检测而不是 CAC 评分可能更好地对症状性低危患者进行风险分层，从而可能改善下游护理。
个体 CT 衍生的 CAD 特征的预后价值因心血管风险类别而异。
存在阻塞性冠状动脉狭窄≥50%无论心血管风险如何都具有最高的预后价值。
CAC 在高风险和 HRP 在低心血管风险中具有独立的预后价值。
