Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Clin Res Cardiol. 2024 Mar;113(3):433-445. doi: 10.1007/s00392-023-02313-1. Epub 2023 Oct 4.
Coronary computed tomography angiography (CCTA) enables improved diagnosis of subclinical, coronary artery disease (CAD). This retrospective cohort study investigated the association between different treatment modalities guided by CCTA and the prevention of major adverse cardiovascular events (MACEs) in patients with stable CAD.
From 2005 to 2013, a total of 9338 patients, including both asymptomatic individuals with risk factors and symptomatic patients with suspected CAD, who underwent CCTA were analyzed. The patients were categorized into one of three groups based on results of CCTA: obstructive CAD (≥ 50% stenosis in at least one vessel), non-obstructive CAD (1-49% stenosis in at least one vessel), and no observed CAD (0% stenosis). They were subsequently followed up to assess the treatment they received and the occurrence of MACEs (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or late revascularization).
During an average follow-up period of 9.9 ± 2.4 years, patients with obstructive CAD had the highest incidence of MACEs (19.8%), followed by those with non-obstructive CAD and no coronary artery stenosis (10.3 and 5.5%, respectively). After adjusting for confounding variables, it was found that patients treated with statins alone were the least likely to develop MACEs in all three groups, compared to those receiving no treatment, with hazard ratios (95% CI) of 0.43 (0.32, 0.58), 0.47 (0.34, 0.64), and 0.46 (0.31, 0.69), respectively. In patients with obstructive CAD, treatment with a combination of statin and aspirin, or early revascularization was associated with a lower likelihood of experiencing MACEs compared to no treatment with hazard ratios of 0.43 (0.33, 0.58) and 0.64 (0.43, 0.97), respectively.
CCTA offers useful guidance for the treatment of patients with stable CAD and shows potential for prevention of CV events. However, the full validation of a given strategy utilizing CCTA will require a prospective longitudinal study, utilizing a randomized clinical trial design.
冠状动脉计算机断层扫描血管造影术（CCTA）可提高亚临床冠状动脉疾病（CAD）的诊断水平。本回顾性队列研究调查了 CCTA 指导下的不同治疗方式与稳定型 CAD 患者主要不良心血管事件（MACE）预防之间的关系。
2005 年至 2013 年，共分析了 9338 例接受 CCTA 的患者，包括无症状伴危险因素的个体和疑似 CAD 的有症状患者。根据 CCTA 结果，患者分为三组：阻塞性 CAD（至少一支血管≥50%狭窄）、非阻塞性 CAD（至少一支血管 1-49%狭窄）和无观察到的 CAD（无狭窄）。随后对他们进行随访，以评估他们接受的治疗和 MACE（心血管死亡、非致死性心肌梗死、非致死性卒中和晚期血运重建）的发生情况。
在平均 9.9±2.4 年的随访期间，阻塞性 CAD 患者的 MACE 发生率最高（19.8%），其次是非阻塞性 CAD 和无冠状动脉狭窄患者（分别为 10.3%和 5.5%）。在调整混杂因素后，发现与未治疗组相比，三组中仅接受他汀类药物治疗的患者发生 MACE 的可能性最小，危险比（95%CI）分别为 0.43（0.32，0.58）、0.47（0.34，0.64）和 0.46（0.31，0.69）。在阻塞性 CAD 患者中，与未治疗组相比，联合应用他汀类药物和阿司匹林治疗或早期血运重建与较低的 MACE 发生率相关，危险比分别为 0.43（0.33，0.58）和 0.64（0.43，0.97）。
CCTA 为稳定型 CAD 患者的治疗提供了有用的指导，并显示出预防 CV 事件的潜力。然而，利用 CCTA 验证特定策略的全部效果需要一项前瞻性纵向研究，采用随机临床试验设计。
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