Aga Khan University, Pakistan.
Glob Heart. 2024 Oct 28;19(1):80. doi: 10.5334/gh.1365. eCollection 2024.
The absence of CAC in asymptomatic individuals is associated with a very low incidence of cardiovascular events. Of symptomatic patients, 1-2% with zero CAC score have non-calcified coronary artery atherosclerosis, and at least one third of cardiovascular events occur in individuals with zero CAC. South Asians (SA) have proportionally higher case fatality rates for CVD, relatively younger age of presentation, and accelerated rate of atherosclerosis when compared with other ethnic groups.
All consecutive patients who underwent a CTCA to evaluate angina or angina-equivalent symptoms during the study duration were enrolled retrospectively. Patients with prior myocardial infarction, history of revascularization, and congenital heart disease were excluded. MACE was defined as the total of cardiac death, non-fatal myocardial infarction, and/or non-elective revascularization.
A total of 534 patients were enrolled after final exclusion. The mean age was 53 years ± 11. Males constituted 68.4% of the study population. Dyslipidemia was the most common co-morbid condition identified (50%), followed by diabetes (18.4%) and hypertension (3.6%). At least 28.8% of patients with zero CAC scores had the presence of coronary artery disease (soft plaque) of any degree. Obstructive CAD (>50%) was present in 5.8% of patients. Follow-up was available for 61.4% of patients. On a mean follow-up of 96.6 months ± 49.8 (range 21-194 months), all-cause MACE was observed in 8.8% of patients. The most common MACE was angina (3.96%) and all-cause mortality (3%). The baseline characteristics and MACE did not differ in patients with and without obstructive CAD. The baseline characteristics did not differ significantly between patients with and without MACE.
The incidence of soft plaque in this SA cohort is higher than that reported in international studies. However, in symptomatic SA, a CAC score of zero carries a good long-term prognosis, irrespective of the degree of CAD.
在无症状个体中不存在 CAC 与心血管事件的发生率非常低有关。在有症状的患者中，有 1-2%的零 CAC 评分患者存在非钙化性冠状动脉粥样硬化，至少有三分之一的心血管事件发生在零 CAC 的患者中。与其他族裔群体相比，南亚人（SA）的 CVD 病死率比例更高，发病年龄相对更年轻，动脉粥样硬化进展速度更快。
所有连续接受 CTCA 检查以评估研究期间心绞痛或等效症状的患者均被回顾性纳入。排除有既往心肌梗死、血运重建史和先天性心脏病的患者。MACE 定义为心脏死亡、非致死性心肌梗死和/或非选择性血运重建的总和。
最终排除后，共纳入 534 例患者。平均年龄为 53 岁±11 岁。男性占研究人群的 68.4%。血脂异常是最常见的合并症（50%），其次是糖尿病（18.4%）和高血压（3.6%）。至少有 28.8%的零 CAC 评分患者存在任何程度的冠状动脉疾病（软斑块）。5.8%的患者存在阻塞性 CAD（>50%）。61.4%的患者可获得随访。平均随访 96.6 个月±49.8（范围 21-194 个月），8.8%的患者发生全因 MACE。最常见的 MACE 是心绞痛（3.96%）和全因死亡率（3%）。有和没有阻塞性 CAD 的患者之间的基线特征和 MACE 没有差异。有和没有 MACE 的患者之间的基线特征没有显著差异。
在这个 SA 队列中，软斑块的发生率高于国际研究报道的发生率。然而，在有症状的 SA 中，即使存在 CAD 程度，零 CAC 评分也具有良好的长期预后。
