Otsuka Kenichiro, Ishikawa Hirotoshi, Yamaura Hiroki, Hojo Kana, Kono Yasushi, Shimada Kenei, Kasayuki Noriaki, Fukuda Daiju
Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine.
Department of Cardiovascular Medicine, Fujiikai Kashibaseiki Hospital.
J Atheroscler Thromb. 2024 Mar 1;31(3):273-287. doi: 10.5551/jat.64251. Epub 2023 Sep 27.
Wide volume scan (WVS) coronary computed tomography angiography (CCTA) enables aortic arch visualization. This study assessed whether the thoracic aortic plaque burden (TAPB) score can predict major cardiovascular adverse events (MACE) in addition to and independently of other obstructive coronary artery disease (CAD) attributes.
This study included patients with suspected CAD who underwent CCTA (n=455). CCTA-WVS was used to assess CAD and the prognostic capacity of TAPB scores. Data analysis included the coronary artery calcification score (CACS), CAD status and extent, and TAPB score, calculated as the sum of plaque thickness and plaque angle at five thoracic aortic segments. The primary endpoint was MACE defined as a composite event comprised of ischemic stroke, acute coronary syndrome, and cardiovascular death.
During a mean follow-up period of 2.8±0.9 years, 40 of 455 (8.8%) patients experienced MACE. In the Cox proportional hazards model adjusted for clinical risks (Suita cardiovascular disease risk score), we identified TAPB score (T3) as a predictor of MACE independent of CACS ＞400 (hazards ratio [HR], 2.91; 95% confidence interval [CI], 1.26-6.72; p=0.012) or obstructive CAD (HR, 2.83; 95% CI, 1.30-6.18; p=0.009). The area under the curve for predicting MACE improved from 0.75 to 0.795 (p value=0.008) when TAPB score was added to CACS ＞400 and obstructive CAD.
We found that comprehensive non-invasive evaluation of TAPB and CAD has prognostic value in MACE risk stratification for suspected CAD patients undergoing CCTA.
宽容积扫描（WVS）冠状动脉计算机断层扫描血管造影（CCTA）能够显示主动脉弓。本研究评估了胸主动脉斑块负荷（TAPB）评分除其他阻塞性冠状动脉疾病（CAD）特征之外以及独立于这些特征之外，是否能够预测主要心血管不良事件（MACE）。
本研究纳入了接受CCTA检查的疑似CAD患者（n = 455）。采用CCTA-WVS评估CAD以及TAPB评分的预后能力。数据分析包括冠状动脉钙化评分（CACS）、CAD状态和范围，以及TAPB评分，该评分通过五个胸主动脉节段的斑块厚度和斑块角度之和计算得出。主要终点是MACE，定义为缺血性卒中、急性冠状动脉综合征和心血管死亡组成的复合事件。
在平均2.8±0.9年的随访期内，455例患者中有40例（8.8%）发生MACE。在根据临床风险（Suita心血管疾病风险评分）进行校正的Cox比例风险模型中，我们确定TAPB评分（T3）是独立于CACS＞400（风险比[HR]，2.91；95%置信区间[CI]，1.26 - 6.72；p = 0.012）或阻塞性CAD（HR，2.83；95% CI，1.30 - 6.18；p = 0.009）的MACE预测因子。当将TAPB评分添加到CACS＞400和阻塞性CAD中时，预测MACE的曲线下面积从0.75提高到0.795（p值 = 0.008）。
我们发现，对TAPB和CAD进行全面的非侵入性评估对于接受CCTA检查的疑似CAD患者的MACE风险分层具有预后价值。
