Ansari Salman, Pourafkari Leili, Kinninger April, Manubolu Venkat, Budoff Matthew J
California University of Science and Medicine - School of Medicine, Colton, CA, USA.
Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA.
J Cardiovasc Comput Tomogr. 2024 Mar-Apr;18(2):137-141. doi: 10.1016/j.jcct.2023.12.001. Epub 2023 Dec 7.
Use of coronary artery calcium (CAC) continues to expand, and several different categories of risk have been developed. Some categorize CAC as <10, 11-100 and > 100, while others use CAC = 0,1-10, 11-100 and > 100 as categories. We sought to evaluate the plaque burden in patients with CAC 0, 1-10 and 11-100 to evaluate the best use of CAC scoring for risk assessment.
Patients were recruited from existing prospective CCTA trials with CAC scores ≤100 and quantitative coronary plaque analysis (QAngio, Medis). CAC was categorized into three groups: zero (CAC = 0), minimal (CAC 1-10), and mild (CAC 11-100). Plaque levels (low attenuated, fibrous, fibro-fatty, dense calcified, total non-calcified) were assessed using multivariable linear regression adjusted for cardiovascular risk factors (age, ethnicity, BMI, gender, hypertension, dyslipidemia, diabetes mellitus, past smoking).
378 subjects were included, with an average age of 53.9 ± 10.7 years and 53 % female. Among them, 51 % had 0 CAC, 16 % had minimal CAC (scores 1-10), and 33 % had mild CAC (scores 11-100). The minimal and mild CAC groups were significantly older, with higher rates of diabetes, hypertension, and hyperlipidemia. Multivariable analysis found no significant difference in low attenuated, fibro-fatty, and dense calcified plaque levels between the minimal and zero CAC groups. However, minimal CAC subjects had significantly higher fibrous, total non-calcified, and total plaque volumes than zero CAC. All plaque types were significantly higher in the mild group when comparing mild CAC to minimal CAC.
Individuals with minimal calcium scores (1-10) had greater noncalcified coronary plaque (NCAP) and total plaque volume than individuals with a calcium score of zero. The increased presence of NCAP and total plaque volume in the minimal CAC (1-10) is clinically significant and place those patients at higher coronary vascular disease (CVD) risk than individuals with absent CAC (CAC = zero). Therefore, the use of CAC = 0, 1-10 and 11-100 is prudent to better categorize CVD risk.
冠状动脉钙化（CAC）的应用持续增加，并且已形成了几种不同的风险类别。一些将CAC分为<10、11 - 100和>100，而另一些则使用CAC = 0、1 - 10、11 - 100和>100作为类别。我们旨在评估CAC为0、1 - 10和11 - 100的患者的斑块负荷，以评估CAC评分在风险评估中的最佳应用。
从现有的前瞻性CCTA试验中招募CAC评分≤100且进行了冠状动脉斑块定量分析（QAngio，Medis）的患者。CAC被分为三组：零（CAC = 0）、轻度（CAC 1 - 10）和中度（CAC 11 - 100）。使用针对心血管危险因素（年龄、种族、BMI、性别、高血压、血脂异常、糖尿病、既往吸烟）进行调整的多变量线性回归评估斑块水平（低衰减、纤维、纤维脂肪、致密钙化、总非钙化）。
纳入378名受试者，平均年龄53.9±10.7岁，女性占53%。其中，51%的患者CAC为0，16%的患者有轻度CAC（评分1 - 10），33%的患者有中度CAC（评分11 - 100）。轻度和中度CAC组年龄显著更大，糖尿病、高血压和高脂血症的发生率更高。多变量分析发现，轻度和零CAC组之间在低衰减、纤维脂肪和致密钙化斑块水平上无显著差异。然而，轻度CAC受试者的纤维、总非钙化和总斑块体积显著高于零CAC受试者。将中度CAC与轻度CAC相比，所有斑块类型在中度组中均显著更高。
钙评分低（1 - 10）的个体比钙评分为零的个体具有更大的非钙化冠状动脉斑块（NCAP）和总斑块体积。轻度CAC（1 - 10）中NCAP和总斑块体积的增加具有临床意义，使这些患者比无CAC（CAC = 零）的个体具有更高的冠状动脉血管疾病（CVD）风险。因此，使用CAC = 0、1 - 10和11 - 100来更好地分类CVD风险是谨慎的做法。
