Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.
Int J Cardiovasc Imaging. 2023 Nov;39(11):2247-2254. doi: 10.1007/s10554-023-02918-7. Epub 2023 Aug 17.
To explore the relationship between comprehensive assessment of coronary atherosclerosis by coronary CT angiography (CCTA) and all-cause mortality and non-fatal myocardial infarction in the Chinese population. Sixty-three patients from the prospective long-term study who experienced major adverse cardiovascular events (MACE) during the follow-up were included. No-MACE patients were 1:1 propensity-matched. Various qualitative and quantitative CCTA parameters, such as coronary artery calcium score (CACS), high-risk plaque, coronary artery disease (CAD) severity, number of obstructive vessels, segment involvement score (SIS), segment stenosis score (SSS), computed tomography-adapt Leaman score (CT-LeSc), and peri-coronary adipose tissue (PCAT) CT attenuation, were compared between both groups. Cox regression analysis was performed to determine the association between CCTA parameters and MACE. The MACE group had higher CACS, more high-risk plaques, more obstructive CAD, more obstructive vessels, higher PCAT CT attenuation, and higher coronary atherosclerotic burden (SIS: 5.76 ± 3.36 vs. 2.84 ± 3.07; SSS: 11.06 ± 8.41 vs. 3.94 ± 4.78; CT-LeSc: 11.25 ± 6.57 vs. 5.49 ± 5.82) than the control group (all p < 0.05). On multivariable analysis, hazard ratios were 1.058 for the SSS (p = 0.004), and 2.152 for the obstructive CAD. When the burden of coronary atherosclerosis was defined as the CT-LeSc, hazard ratios were 1.057 for the CT-LeSc (p = 0.036), and 2.272 for the obstructive CAD. The SSS, CT-LeSc, and presence of obstructive CAD were independently associated with the all-cause mortality and non-fatal myocardial infarction in the suspected CADs in the Chinese population.
探讨冠状动脉 CT 血管造影（CCTA）对冠状动脉粥样硬化的综合评估与全因死亡率和非致死性心肌梗死的关系。该研究纳入了前瞻性长期研究中在随访期间发生主要不良心血管事件（MACE）的 63 例患者。采用 1:1 倾向评分匹配方法匹配无 MACE 患者。比较两组患者的各种定性和定量 CCTA 参数，如冠状动脉钙评分（CACS）、高危斑块、冠状动脉疾病（CAD）严重程度、狭窄血管数量、节段累及评分（SIS）、节段狭窄评分（SSS）、计算机断层扫描适应 Leaman 评分（CT-LeSc）和冠状动脉周围脂肪组织（PCAT）CT 衰减值。采用 Cox 回归分析确定 CCTA 参数与 MACE 的相关性。MACE 组的 CACS 较高、高危斑块较多、阻塞性 CAD 较多、阻塞性血管较多、PCAT CT 衰减值较高、冠状动脉粥样硬化负担较高（SIS：5.76±3.36 比 2.84±3.07；SSS：11.06±8.41 比 3.94±4.78；CT-LeSc：11.25±6.57 比 5.49±5.82）（均 p<0.05）。多变量分析显示，SSS 的危险比为 1.058（p=0.004），阻塞性 CAD 的危险比为 2.152。当冠状动脉粥样硬化负担定义为 CT-LeSc 时，CT-LeSc 的危险比为 1.057（p=0.036），阻塞性 CAD 的危险比为 2.272。SSS、CT-LeSc 和阻塞性 CAD 的存在与中国人群疑似 CAD 中的全因死亡率和非致死性心肌梗死独立相关。
