Meng Qingchao, An Yunqiang, Zhao Li, Zhao Na, Yan Hankun, Wang Jingxi, Zhou Yutao, Lu Bin, Gao Yang
Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.
J Thorac Imaging. 2024 Nov 1;39(6):385-391. doi: 10.1097/RTI.0000000000000793. Epub 2024 Jul 15.
This study investigated the prognostic value and risk reclassification ability of coronary atherosclerosis progression through serial coronary computed tomography angiography (CCTA).
This study enrolled patients with suspected or confirmed coronary artery disease who underwent serial CCTA. Coronary atherosclerosis progression was represented by coronary artery calcium score (CACS) and segment stenosis score (SSS) progression. The baseline and follow-up CCTA characteristics and coronary atherosclerosis progression were compared. Furthermore, the incremental prognostic value and reclassification ability of three models (model 1, baseline risk factors; model 2, model 1 + SSS; and model 3, model 2 + SSS progression) for major adverse cardiovascular events (MACEs) were compared.
In total, 516 patients (aged 56.40 ± 9.56 y, 67.4% men) were enrolled. During a mean follow-up of 65.29 months, 114 MACE occurred. The MACE group exhibited higher CACS and SSS than the non-MACE group at baseline and follow-up CCTA ( P < 0.001), and demonstrated higher coronary atherosclerosis progression than the non-MACE group (ΔSSS: 2.63 ± 2.50 vs 1.06 ± 1.78, P < 0.001; ΔCACS: 115.15 ± 186.66 vs 89.91 ± 173.08, P = 0.019). SSS progression provided additional prognostic information (C-index = 0.757 vs 0.715, P < 0.001; integrated discrimination index = 0.066, P < 0.001) and improved the reclassification ability of risk (categorical-net reclassification index = 0.149, P = 0.015) compared with model 2.
Coronary atherosclerosis progression through CCTA significantly increased the prognostic value and risk stratification for MACE compared with baseline risk factor evaluation and CCTA only.
本研究通过系列冠状动脉计算机断层扫描血管造影（CCTA）探讨冠状动脉粥样硬化进展的预后价值和风险重新分类能力。
本研究纳入了接受系列CCTA检查的疑似或确诊冠心病患者。冠状动脉粥样硬化进展以冠状动脉钙化积分（CACS）和节段狭窄积分（SSS）进展表示。比较了基线和随访时的CCTA特征及冠状动脉粥样硬化进展情况。此外，还比较了三种模型（模型1，基线危险因素；模型2，模型1 + SSS；模型3，模型2 + SSS进展）对主要不良心血管事件（MACE）的增量预后价值和重新分类能力。
共纳入516例患者（年龄56.40±9.56岁，男性占67.4%）。在平均65.29个月的随访期间，发生了114例MACE。MACE组在基线和随访CCTA时的CACS和SSS均高于非MACE组（P < 0.001），且冠状动脉粥样硬化进展高于非MACE组（ΔSSS：2.63±2.50 vs 1.06±1.78，P < 0.001；ΔCACS：115.15±186.66 vs 89.91±173.08，P = 0.019）。与模型2相比，SSS进展提供了额外的预后信息（C指数 = 0.757 vs 0.715，P < 0.001；综合判别指数 = 0.066，P < 0.001），并提高了风险的重新分类能力（分类净重新分类指数 = 0.149，P = 0.015）。
与仅进行基线危险因素评估和CCTA相比，通过CCTA评估冠状动脉粥样硬化进展显著提高了MACE的预后价值和风险分层能力。
