He Xingwei, Maung Soe, Ramasamy Anantharaman, Mohamed Mohamed O, Bajaj Retesh, Yap Nathan Angelo Lecaros, Karaduman Medeni, Zhang Yaojun, Kitslaar Pieter, Broersen Alexander, Reiber Johan H C, Dijkstra Jouke, Serruys Patrick W, Moon James C, Baumbach Andreas, Torii Ryo, Pugliese Francesca, Bourantas Christos V
Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Soc Cardiovasc Angiogr Interv. 2024 Mar 26;3(3Part B):101308. doi: 10.1016/j.jscai.2024.101308. eCollection 2024 Mar.
Coronary artery calcium score (CACS) is an established marker of coronary artery disease (CAD) and has been extensively used to stratify risk in asymptomatic individuals. However, the value of CACS in predicting plaque morphology in patients with advanced CAD is less established. The present analysis aims to assess the association between CACS and plaque characteristics detected by near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) imaging in patients with obstructive CAD.
Seventy patients with obstructive CAD underwent coronary computed tomography angiography (CTA) and 3-vessel NIRS-IVUS imaging were included in the present analysis. The CTA data were used to measure the CACS in the entire coronary tree and the segments assessed by NIRS-IVUS, and these estimations were associated with the NIRS-IVUS measurements at a patient and segment level.
In total, 65 patients (188 segments) completed the study protocol and were included in the analysis. A weak correlation was noted between the CACS, percent atheroma volume (r = 0.271, = .002), and the calcific burden measured by NIRS-IVUS (r = 0.648, < .001) at patient-level analysis. Conversely, there was no association between the CACS and the lipid content, or the incidence of high-risk plaques detected by NIRS. Linear regression analysis at the segment level demonstrated an association between the CACS and the total atheroma volume (coefficient, 0.087; 95% CI, 0.024-0.149; = .008) and the calcific burden (coefficient, 0.117; 95% CI, 0.048-0.186; = .001), but there was no association between the lipid content or the incidence of high-risk lesions.
In patients with obstructive CAD, the CACS is not associated with the lipid content or plaque phenotypes. These findings indicate that the CACS may have a limited value for screening or stratifying cardiovascular risk in symptomatic patients with a high probability of CAD.
冠状动脉钙化积分（CACS）是冠状动脉疾病（CAD）的既定标志物，已被广泛用于对无症状个体进行风险分层。然而，CACS在预测晚期CAD患者斑块形态方面的价值尚不明确。本分析旨在评估CACS与通过近红外光谱血管内超声（NIRS-IVUS）成像检测到的阻塞性CAD患者斑块特征之间的关联。
本分析纳入了70例阻塞性CAD患者，这些患者接受了冠状动脉计算机断层扫描血管造影（CTA）和三支血管的NIRS-IVUS成像。CTA数据用于测量整个冠状动脉树以及由NIRS-IVUS评估的节段的CACS，这些估计值在患者和节段水平上与NIRS-IVUS测量值相关。
共有65例患者（188个节段）完成了研究方案并纳入分析。在患者水平分析中，CACS与动脉粥样硬化体积百分比（r = 0.271，P = 0.002）以及通过NIRS-IVUS测量的钙化负荷（r = 0.648，P < 0.001）之间存在弱相关性。相反，CACS与脂质含量或NIRS检测到的高危斑块发生率之间没有关联。节段水平的线性回归分析表明，CACS与总动脉粥样硬化体积（系数，0.087；95%可信区间，0.024 - 0.149；P = 0.008）和钙化负荷（系数，0.117；95%可信区间，0.048 - 0.186；P = 0.001）之间存在关联，但与脂质含量或高危病变发生率之间没有关联。
在阻塞性CAD患者中，CACS与脂质含量或斑块表型无关。这些发现表明，CACS在筛查或分层CAD可能性高的有症状患者的心血管风险方面可能价值有限。
