Rossdale Jennifer, Graby John, Harris Maredudd, Jones Calum, Greenish Davyd, Bartlett Jessica, Gilroy Andrew, Sanghera Jamie, Pauling John D, Skeoch Sarah, Flower Victoria, Mackenzie Ross Rob, Suntharalingam Jay, Rodrigues Jonathan Cl
Respiratory Department, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
Department of Life Sciences, University of Bath, Bath, UK.
J Scleroderma Relat Disord. 2024 Oct;9(3):192-202. doi: 10.1177/23971983241264090. Epub 2024 Aug 11.
Coronary artery calcification assessed on thoracic computed tomography represents the calcific component of established coronary artery disease, is a biomarker of total atheromatous plaque burden and predicts mortality. Systemic sclerosis is a pro-inflammatory condition, and inflammation is also a driver of coronary artery disease. We assessed coronary artery calcification prevalence, mortality risk and potential clinical impact on primary prevention in a cohort of patients with systemic sclerosis, differentiated by clinical phenotype including the presence of interstitial lung disease and pulmonary arterial hypertension.
Retrospective analysis of 258 computed tomographies in systemic sclerosis patients from three prospectively maintained clinical and research databases at a single tertiary rheumatology/pulmonary hypertension (PH) service between March 2007 and September 2020 (mean age = 65 ± 12, 14% male). Co-morbidities, statin prescription and all-cause mortality were recorded. Patients were subtyped according to underlying systemic sclerosis complications. Computed tomographies were re-reviewed for coronary artery calcification; severity was graded using a 4-point scale per vessel and summed for total coronary artery calcification score. The impact of reporting coronary artery calcification was assessed against pre-existing statin prescriptions.
Coronary artery calcification was present in 58% (149/258). Coronary artery calcification was more prevalent in systemic sclerosis-pulmonary arterial hypertension than in systemic sclerosis subgroups with interstitial lung disease or without pulmonary arterial hypertension, controlling for age, sex, co-morbidities and smoking status (71%; (13) = 81.4; < 0.001). The presence and severity of coronary artery calcification were associated with increased risk of mortality independently of age and co-morbidities (hazard ratio = 2.8; 95% confidence interval = 1.2-6.6; = 0.018). The 'number needed to report' coronary artery calcification presence to potentially impact management was 3.
Coronary artery calcification is common in systemic sclerosis. Coronary artery calcification predicts mortality independently of age and confounding co-morbidities which suggests this finding has clinical relevance and is a potential target for screening and therapeutic intervention.
胸部计算机断层扫描评估的冠状动脉钙化代表已确诊冠状动脉疾病的钙化成分，是总动脉粥样硬化斑块负荷的生物标志物，并可预测死亡率。系统性硬化症是一种促炎状态，炎症也是冠状动脉疾病的驱动因素。我们评估了系统性硬化症患者队列中冠状动脉钙化的患病率、死亡风险及其对一级预防的潜在临床影响，并根据包括间质性肺疾病和肺动脉高压在内的临床表型进行了区分。
对2007年3月至2020年9月期间在一家三级风湿病/肺动脉高压（PH）服务机构的三个前瞻性维护的临床和研究数据库中的258例系统性硬化症患者的计算机断层扫描进行回顾性分析（平均年龄 = 65 ± 12岁，14%为男性）。记录合并症、他汀类药物处方和全因死亡率。根据潜在的系统性硬化症并发症对患者进行亚型分类。对计算机断层扫描重新评估冠状动脉钙化情况；严重程度按每支血管4分制分级，并汇总得出总冠状动脉钙化评分。根据现有的他汀类药物处方评估报告冠状动脉钙化的影响。
58%（149/258）的患者存在冠状动脉钙化。在控制年龄、性别、合并症和吸烟状况后，系统性硬化症 - 肺动脉高压患者中冠状动脉钙化比合并间质性肺疾病或无肺动脉高压的系统性硬化症亚组更常见（71%；χ²(1) = 81.4；P < 0.001）。冠状动脉钙化的存在和严重程度与年龄和合并症无关，独立增加死亡风险（风险比 = 2.8；95%置信区间 = 1.2 - 6.
