Gall Emmanuel, Pezel Théo, Toupin Solenn, Hovasse Thomas, Unterseeh Thierry, Chevalier Bernard, Sanguineti Francesca, Champagne Stéphane, Neylon Antoinette, Benamer Hakim, Akodad Mariama, Gonçalves Trecy, Lequipar Antoine, Dillinger Jean Guillaume, Henry Patrick, Ah-Singh Tania, Hamzi Lounis, Bousson Valérie, Garot Philippe, Garot Jérôme
Université Paris-Cité, Department of Cardiology, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010, Paris, France.
Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris Sud (ICPS), Ramsay-Santé, 91300, Massy, France.
Eur Radiol. 2025 Jan 24. doi: 10.1007/s00330-025-11353-2.
To determine whether plaque composition analysis defined by cardiac CT can provide incremental prognostic value above coronary artery disease (CAD) burden markers in symptomatic patients with obstructive CAD.
Between 2009 and 2019, a multicentric registry included all consecutive symptomatic patients with obstructive CAD (at least one ≥ 50% stenosis on CCTA) and was followed for major adverse cardiovascular (MACE) defined by cardiovascular death or nonfatal myocardial infarction. Each coronary segment was scored visually for both the degree of stenosis and composition of plaque, which were classified as non-calcified, mixed, or calcified. To assess the prognostic value of each CCTA findings, different multivariable Cox regression models were used: model 1: clinical (traditional risk factors); model 2: model 1 + CAD burden (number of proximal segments with stenosis ≥ 50% + number of vessels with obstructive CAD); and model 3: model 2 + plaques feature (number of segments with non-calcified plaque).
Of 2312 patients (mean age 70 ± 12 years, 46% men), 319 experienced a MACE (13.8%) (median follow-up: 6.7 years (5.9-9.1)). The number of proximal segments with ≥ 50% stenosis, the number of vessels with obstructive CAD, and the number of segments with non-calcified plaque were all independently associated with MACEs (all p < 0.001). The addition of plaque composition analysis (model 3) showed the best improvement in model discrimination and reclassification (C-statistic improvement = 0.03; net reclassification improvement = 28.6%; integrative discrimination index = 5.4%, all p < 0.001).
In this population, the analysis of coronary plaque composition had an incremental prognostic value to predict MACEs above a model combining traditional risk factors and CAD burden.
Question Several coronary computed tomography angiography (CCTA) studies have shown the potential interest of plaque composition analysis, which can be further evaluated. Findings In symptomatic patients with obstructive coronary artery disease (CAD), plaque composition analysis had an incremental prognostic value above a model combining traditional risk factors and CAD burden. Clinical relevance In symptomatic patients with obstructive CAD, plaque composition analysis using CCTA has a strong incremental prognostic value above a model combining traditional risk factors and CAD burden, thus translating into a more accurate long-term major adverse cardiovascular event prediction.
确定心脏CT定义的斑块成分分析能否在有症状的阻塞性冠心病患者中，提供高于冠心病（CAD）负荷标志物的增量预后价值。
2009年至2019年间，一项多中心注册研究纳入了所有连续性有症状的阻塞性CAD患者（CCTA至少有一处≥50%狭窄），并对心血管死亡或非致死性心肌梗死定义的主要不良心血管事件（MACE）进行随访。对每个冠状动脉节段的狭窄程度和斑块成分进行视觉评分，斑块分为非钙化、混合或钙化。为评估每个CCTA结果的预后价值，使用了不同的多变量Cox回归模型：模型1：临床因素（传统危险因素）；模型2：模型1 + CAD负荷（狭窄≥50%的近端节段数 + 阻塞性CAD的血管数）；模型3：模型2 + 斑块特征（非钙化斑块节段数）。
在2312例患者（平均年龄70±12岁，46%为男性）中，319例发生了MACE（13.8%）（中位随访时间：6.7年（5.9 - 9.1年））。狭窄≥50%的近端节段数、阻塞性CAD的血管数以及非钙化斑块节段数均与MACE独立相关（均p < 0.001）。添加斑块成分分析（模型3）显示模型判别和重新分类有最佳改善（C统计量改善 = 0.03；净重新分类改善 = 28.6%；综合判别指数 = 5.4%，均p < 0.001）。
在该人群中，冠状动脉斑块成分分析对预测MACE具有高于结合传统危险因素和CAD负荷的模型的增量预后价值。
问题 多项冠状动脉计算机断层扫描血管造影（CCTA）研究显示了斑块成分分析的潜在价值，可进一步评估。发现 在有症状的阻塞性冠状动脉疾病（CAD）患者中，斑块成分分析具有高于结合传统危险因素和CAD负荷的模型的增量预后价值。临床意义 在有症状的阻塞性CAD患者中，使用CCTA进行斑块成分分析具有高于结合传统危险因素和CAD负荷的模型的强大增量预后价值，从而转化为更准确的长期主要不良心血管事件预测。
