Franke Kyle B, Montarello Nicholas J, Nelson Adam J, Marathe Jessica A, Wong Dennis T L, Tavella Rosanna, Arstall Margaret, Zeitz Christopher, Worthley Matthew I, Beltrame John F, Psaltis Peter J
Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.
Int J Cardiol Heart Vasc. 2024 May 3;52:101417. doi: 10.1016/j.ijcha.2024.101417. eCollection 2024 Jun.
Although the clinical factors associated with progression of coronary artery disease have been well studied, the angiographic predictors are less defined.
Our objective was to study the clinical and angiographic factors that associate with progression of coronary artery stenoses.
We conducted a retrospective analysis of consecutive patients undergoing multiple, clinically indicated invasive coronary angiograms with an interval greater than 6 months, between January 2013 and December 2016. Lesion segments were analysed using Quantitative Coronary Angiography (QCA) if a stenosis ≥ 20 % was identified on either angiogram. Stenosis progression was defined as an increase ≥ 10 % in stenosis severity, with progressor groups analysed on both patient and lesion levels. Mixed-effects regression analyses were performed to evaluate factors associated with progression of individual stenoses.
199 patients were included with 881 lesions analysed. 108 (54.3 %) patients and 186 (21.1 %) stenoses were classified as progressors. The median age was 65 years (IQR 56-73) and the median interval between angiograms was 2.1 years (IQR 1.2-3.0). On a patient level, age, number of lesions and presence of multivessel disease at baseline were each associated with progressor status. On a lesion level, presence of a stenosis downstream (OR 3.07, 95 % CI 2.04-4.63, < 0.001) and circumflex artery stenosis location (OR 1.81, 95 % CI 1.21-2.7, = 0.004) were associated with progressor status. Other lesion characteristics did not significantly impact progressor status or change in stenosis severity.
Coronary lesions which have a downstream stenosis may be at increased risk of stenosis progression. Further research into the mechanistic basis of this finding is required, along with its implications for plaque vulnerability and clinical outcomes.
尽管与冠状动脉疾病进展相关的临床因素已得到充分研究，但血管造影预测因素的定义尚不明确。
我们的目的是研究与冠状动脉狭窄进展相关的临床和血管造影因素。
我们对2013年1月至2016年12月期间连续接受多次、临床指征性侵入性冠状动脉造影且间隔时间超过6个月的患者进行了回顾性分析。如果在任何一次血管造影中发现狭窄≥20%，则使用定量冠状动脉造影（QCA）分析病变节段。狭窄进展定义为狭窄严重程度增加≥10%，并在患者和病变水平上对进展组进行分析。进行混合效应回归分析以评估与个体狭窄进展相关的因素。
纳入199例患者，分析881个病变。108例（54.3%）患者和186个（21.1%）狭窄被归类为进展者。中位年龄为65岁（四分位间距56 - 73），血管造影之间的中位间隔时间为2.1年（四分位间距1.2 - 3.0）。在患者水平上，年龄、病变数量和基线时多支血管病变的存在均与进展者状态相关。在病变水平上，下游存在狭窄（比值比3.07，95%置信区间2.04 - 4.63，P < 0.001）和回旋支动脉狭窄部位（比值比1.81，95%置信区间1.21 - 2.7，P = 0.004）与进展者状态相关。其他病变特征对进展者状态或狭窄严重程度的变化没有显著影响。
存在下游狭窄的冠状动脉病变可能有更高的狭窄进展风险。需要对这一发现的机制基础及其对斑块易损性和临床结果的影响进行进一步研究。
