Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA.
Department of Medicine, West Virginia University School of Medicine, Morgantown, WV 26506, USA.
J Cardiovasc Comput Tomogr. 2023 Sep-Oct;17(5):302-309. doi: 10.1016/j.jcct.2023.07.003. Epub 2023 Aug 3.
Coronary artery calcium (CAC) scoring is a proven predictor for future adverse cardiovascular events (CVE) in asymptomatic individuals. Data is emerging regarding the usefulness of non-calcified plaque (NCP) assessment on cardiac computed tomography (CCT) angiography in symptomatic patients with a zero CAC score for further risk assessment.
A retrospective review from January 2019 to January 2022 of 696 symptomatic patients with no known CAD and a zero CAC score identified 181 patients with NCP and 515 patients without NCP by a visual assessment on CCT angiography. The primary endpoint was to identify predictors for NCP presence and adverse CVEs (death, myocardial infarction, or cerebrovascular accident) within two years.
Based on logistic regression, age (OR 1.039, 95% CI [1.020-1.058], p < 0.001), diabetes mellitus (OR 2.192, 95% CI [1.307-3.676], p < 0.003), tobacco use (OR 1.748, 95% CI [1.157-2.643], p < 0.008), low-density lipoprotein cholesterol level (OR 1.009, 95% CI [1.003-1.015], p < 0.002), and hypertension (OR 1.613, 95% CI [1.024-2.540], p < 0.039) were found to be predictors of NCP presence. NCP patients had a higher pretest probability for CAD using the Morise risk score (p < 0.001∗), with NCP detection increasing as pretest probability increased from low to high (OR 55.79, 95% CI [24.26-128.26], p < 0.001∗). 457 patients (66%) reached a full two-year period after CCT angiography completion, with NCP patients noted to have shorter follow-up times and higher rates of elective coronary angiography, intervention, and CVEs. The presence of NCP (aOR 2.178, 95% CI [1.025-4.627], p < 0.043) was identified as an independent predictor for future adverse CVEs when adjusted for diabetes mellitus, age, and hypertension.
NCP was identified at high rates (26%) in our symptomatic Appalachian population with no known CAD and a zero CAC score. NCP was identified as an independent predictor of future adverse CVEs within two years.
冠状动脉钙（CAC）评分是预测无症状个体未来心血管不良事件（CVE）的有效指标。越来越多的数据表明，在 CAC 评分结果为零的有症状患者中，通过心脏计算机断层扫描（CCT）血管造影评估非钙化斑块（NCP）对于进一步评估风险具有一定的作用。
本研究回顾性分析了 2019 年 1 月至 2022 年 1 月间 696 名无症状且无已知 CAD 的患者，根据 CCT 血管造影上的视觉评估，其中 181 名患者有 NCP，515 名患者无 NCP。主要终点是确定 NCP 存在和两年内发生不良 CVE（死亡、心肌梗死或脑血管意外）的预测因素。
基于逻辑回归分析，年龄（OR 1.039，95%CI [1.020-1.058]，p < 0.001）、糖尿病（OR 2.192，95%CI [1.307-3.676]，p < 0.003）、吸烟（OR 1.748，95%CI [1.157-2.643]，p < 0.008）、低密度脂蛋白胆固醇水平（OR 1.009，95%CI [1.003-1.015]，p < 0.002）和高血压（OR 1.613，95%CI [1.024-2.540]，p < 0.039）是 NCP 存在的预测因素。NCP 患者使用 Morise 风险评分的 CAD 术前概率更高（p < 0.001∗），随着术前概率从低到高，NCP 的检出率增加（OR 55.79，95%CI [24.26-128.26]，p < 0.001∗）。457 名患者（66%）在 CCT 血管造影完成后达到完整的两年随访期，NCP 患者的随访时间更短，选择性冠状动脉造影、介入和 CVE 的发生率更高。在校正糖尿病、年龄和高血压后，NCP 的存在（aOR 2.178，95%CI [1.025-4.627]，p < 0.043）被确定为未来不良 CVE 的独立预测因素。
在我们患有无症状的阿巴拉契亚地区的人群中，CAC 评分结果为零且无已知 CAD 的人群中，NCP 的检出率较高（26%）。NCP 被确定为未来两年内发生不良 CVE 的独立预测因素。
