Lima Thais Pinheiro, Assuncao Antonildes N, Bittencourt Marcio Sommer, Liberato Gabriela, Arbab-Zadeh Armin, Lima Joao A C, Rochitte Carlos Eduardo
Clinical Hospital HCFMUSP, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil.
Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil.
Eur Radiol. 2023 Aug;33(8):5436-5445. doi: 10.1007/s00330-023-09408-3. Epub 2023 Feb 18.
Coronary computed tomography angiography (coronary CTA) scores based on luminal obstruction, plaque burden, and characteristics are used for prognostication in coronary artery disease (CAD), such as segmental stenosis and plaque extent involvement and Gensini and Leaman scores. The use of coronary CTA scores for the long-term prognosis remains not completely defined. We sought to evaluate the long-term prognosis of CTA scores for cardiovascular events in symptomatic patients with suspected CAD.
The presence and extent of CAD were evaluated by coronary CTA in patients from two multicenter prospective studies, which were classified according to several coronary CTA scores. The primary endpoint was major adverse cardiac events (MACE). Two hundred and twenty-two patients were followed up for a median of 6.8 (6.3-9.1) years, and 73 patients met the composite endpoints of MACE.
Compared to the clinical prediction model, the highest model improvement was observed when added obstructive CAD. After adjustment for the presence of obstructive CAD, the segment involvement score for non-calcified plaque (SIS) was independently associated with MACE, presenting incremental prognostic value over clinical data and CAD severity (χ 39.5 vs 21.2, p < 0.001 for comparison with a clinical model; and χ 39.5 vs 35.6, p = 0.04 for comparison with clinical + CAD severity). Patients with obstructive CAD and SIS > 3 were likely to experience events (HR 4.27, 95% CI 2.17-4.40, p < 0.001).
Coronary CTA plaque-based scores provide incremental long-term prognostic value for up to 7 years. Among patients with obstructive CAD, the presence of extensive non-calcified disease (> 3 coronary segments) is associated with increased cardiovascular risk for late events independently of the presence of obstructive CAD.
• Coronary CTA plaque-based scores are long-term prognostic markers in patients with stable CAD. • Besides obstructive CAD, the segment involvement score of non-calcified disease of 3 or more independently increased the risk of cardiovascular events.
基于管腔阻塞、斑块负荷和特征的冠状动脉计算机断层扫描血管造影（冠状动脉CTA）评分用于冠状动脉疾病（CAD）的预后评估，如节段性狭窄、斑块累及范围以及Gensini和Leaman评分。冠状动脉CTA评分用于长期预后评估的作用尚未完全明确。我们旨在评估有症状的疑似CAD患者中CTA评分对心血管事件的长期预后。
在两项多中心前瞻性研究的患者中，通过冠状动脉CTA评估CAD的存在情况和范围，并根据几种冠状动脉CTA评分进行分类。主要终点是主要不良心脏事件（MACE）。222例患者的中位随访时间为6.8（6.3 - 9.1）年，73例患者达到MACE复合终点。
与临床预测模型相比，添加阻塞性CAD时观察到最高的模型改善。在调整阻塞性CAD的存在后，非钙化斑块节段累及评分（SIS）与MACE独立相关，相对于临床数据和CAD严重程度具有增量预后价值（χ² 39.5对21.2，与临床模型比较p < 0.001；χ² 39.5对35.6，与临床 + CAD严重程度比较p = 0.04）。阻塞性CAD且SIS > 3的患者发生事件的可能性较大（HR 4.27，95% CI 2.17 - 4.40，p < 0.001）。
基于冠状动脉CTA斑块的评分在长达7年的时间里提供了增量长期预后价值。在阻塞性CAD患者中，广泛的非钙化疾病（> 3个冠状动脉节段）的存在与晚期事件的心血管风险增加相关，独立于阻塞性CAD的存在。
• 基于冠状动脉CTA斑块的评分是稳定CAD患者的长期预后标志物。• 除了阻塞性CAD外，3个或更多非钙化疾病的节段累及评分独立增加心血管事件风险。
