丹麦队列前瞻性观察研究：亚临床冠状动脉粥样硬化与心肌梗死风险。

Subclinical Coronary Atherosclerosis and Risk for Myocardial Infarction in a Danish Cohort : A Prospective Observational Cohort Study.

机构信息

Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark (A.F., J.T.K., P.E.S., A.D.K., M.B.M., M.C.deK., M.H.S.).

Department of Clinical Biochemistry and the Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte, Herlev, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (S.A., B.G.N.).

出版信息

Ann Intern Med. 2023 Apr;176(4):433-442. doi: 10.7326/M22-3027. Epub 2023 Mar 28.

DOI:10.7326/M22-3027

PMID:36972540

Abstract

BACKGROUND

Coronary atherosclerosis may develop at an early age and remain latent for many years.

OBJECTIVE

To define characteristics of subclinical coronary atherosclerosis associated with the development of myocardial infarction.

DESIGN

Prospective observational cohort study.

SETTING

Copenhagen General Population Study, Denmark.

PARTICIPANTS

9533 asymptomatic persons aged 40 years or older without known ischemic heart disease.

MEASUREMENTS

Subclinical coronary atherosclerosis was assessed with coronary computed tomography angiography conducted blinded to treatment and outcomes. Coronary atherosclerosis was characterized according to luminal obstruction (nonobstructive or obstructive [≥50% luminal stenosis]) and extent (nonextensive or extensive [one third or more of the coronary tree]). The primary outcome was myocardial infarction, and the secondary outcome was a composite of death or myocardial infarction.

RESULTS

A total of 5114 (54%) persons had no subclinical coronary atherosclerosis, 3483 (36%) had nonobstructive disease, and 936 (10%) had obstructive disease. Within a median follow-up of 3.5 years (range, 0.1 to 8.9 years), 193 persons died and 71 had myocardial infarction. The risk for myocardial infarction was increased in persons with obstructive (adjusted relative risk, 9.19 [95% CI, 4.49 to 18.11]) and extensive (7.65 [CI, 3.53 to 16.57]) disease. The highest risk for myocardial infarction was noted in persons with obstructive-extensive subclinical coronary atherosclerosis (adjusted relative risk, 12.48 [CI, 5.50 to 28.12]) or obstructive-nonextensive (adjusted relative risk, 8.28 [CI, 3.75 to 18.32]). The risk for the composite end point of death or myocardial infarction was increased in persons with extensive disease, regardless of degree of obstruction-for example, nonobstructive-extensive (adjusted relative risk, 2.70 [CI, 1.72 to 4.25]) and obstructive-extensive (adjusted relative risk, 3.15 [CI, 2.05 to 4.83]).

LIMITATION

Mostly White persons were studied.

CONCLUSION

In asymptomatic persons, subclinical, obstructive coronary atherosclerosis is associated with a more than 8-fold elevated risk for myocardial infarction.

PRIMARY FUNDING SOURCE

AP Møller og Hustru Chastine Mc-Kinney Møllers Fond.

摘要

背景

冠状动脉粥样硬化可能在早年发生，并潜伏多年。

目的

确定与心肌梗死发展相关的亚临床冠状动脉粥样硬化的特征。

设计

前瞻性观察队列研究。

地点

丹麦哥本哈根普通人群研究。

参与者

9533 名无症状、年龄在 40 岁或以上且无已知缺血性心脏病的人群。

测量

通过冠状动脉计算机断层血管造影术评估亚临床冠状动脉粥样硬化，该检查对治疗和结果进行了盲法评估。根据管腔阻塞程度（非阻塞性或阻塞性[≥50%管腔狭窄]）和范围（非广泛性或广泛性[三分之一或更多的冠状动脉树]）对冠状动脉粥样硬化进行特征描述。主要结局是心肌梗死，次要结局是死亡或心肌梗死的复合结局。

结果

共有 5114 人（54%）无亚临床冠状动脉粥样硬化，3483 人（36%）为非阻塞性疾病，936 人（10%）为阻塞性疾病。在中位数为 3.5 年（范围 0.1 至 8.9 年）的随访期间，193 人死亡，71 人发生心肌梗死。阻塞性（校正相对风险，9.19[95%置信区间，4.49 至 18.11]）和广泛性（7.65[置信区间，3.53 至 16.57]）疾病患者发生心肌梗死的风险增加。在有阻塞性-广泛性亚临床冠状动脉粥样硬化（校正相对风险，12.48[95%置信区间，5.50 至 28.12]）或阻塞性-非广泛性（校正相对风险，8.28[95%置信区间，3.75 至 18.32]）的患者中，发生心肌梗死的风险最高。广泛疾病患者的死亡或心肌梗死复合终点风险增加，而与阻塞程度无关-例如，非阻塞性-广泛性（校正相对风险，2.70[95%置信区间，1.72 至 4.25]）和阻塞性-广泛性（校正相对风险，3.15[95%置信区间，2.05 至 4.83]）。