Jonas Rebecca A, Nurmohamed Nick S, Crabtree Tami R, Aquino Melissa, Jennings Robert S, Choi Andrew D, Lin Fay Y, Lee Sang-Eun, Andreini Daniele, Bax Jeroen, Cademartiri Fillipo, Chinnaiyan Kavitha, Chow Benjamin J W, Conte Edoardo, Cury Ricardo, Feuchtner Gudrun, Hadamitzky Martin, Kim Yong-Jin, Maffei Erica, Marques Hugo, Plank Fabian, Pontone Gianluca, van Rosendael Alexander R, Villines Todd C, Al'Aref Subhi J, Baskaran Lohendran, Cho Iksung, Danad Ibrahim, Heo Ran, Lee Ji Hyun, Rizvi Asim, Stuijfzand Wijnand J, Sung Ji Min, Park Hyung-Bok, Budoff Matthew J, Samady Habib, Shaw Leslee J, Stone Peter H, Virmani Renu, Narula Jagat, Min James K, Earls James P, Chang Hyuk-Jae
Department of Cardiovascular Disease, Rush University Medical Center, 1725 W Harrison St, Chicago, IL 60612.
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
AJR Am J Roentgenol. 2025 Jul 23:1-11. doi: 10.2214/AJR.24.31476.
. Coronary artery calcium (CAC) scoring is used to stratify acute coronary syndrome (ACS) risk. Nonetheless, patients with a CAC score of zero (CAC) remain at risk from noncalcified plaque components. . The purpose of this study was to explore CTA-derived coronary artery plaque characteristics in symptomatic patients with CAC who subsequently have ACS through comparisons with patients with a CAC score greater than 0 (CAC) who subsequently have ACS as well as with patients with CAC who do not subsequently have ACS. . This study entailed a secondary retrospective analysis of prior prospective registry data. The international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry collected longitudinal observational data on symptomatic patients who underwent clinically indicated coronary CTA from January 2004 to May 2010. ICONIC (Incident Coronary Syndromes Identified by CT) was a nested cohort study conducted within CONFIRM that identified patients without known coronary artery disease (CAD) at the time of CTA who did and did not subsequently have ACS (i.e., the ACS and control groups, respectively) and who were propensity matched in a 1:1 ratio on the basis of CAD risk factors and CAD severity on CTA. The present ICONIC substudy selected matched patients in the ACS and control groups who both had documented CAC scores. CTA examinations were analyzed using artificial intelligence software for automated quantitative plaque assessment. In the ACS group, invasive angiography findings were used to identify culprit lesions. . The present study included 216 patients (mean age, 55.6 years; 91 women and 125 men), with 108 patients in each of the ACS and control groups. In the ACS group, 23% ( = 25) of patients had CAC. In the ACS group, culprit lesions in the subsets of patients with CAC and CAC showed no significant differences in fibrous, fibrofatty, or necrotic-core plaque volumes ( > .05). In the CAC subset, patients with ACS, compared with control patients, had greater mean (± SD) fibrous plaque volume (29.4 ± 42.0 vs 5.5 ± 15.2 mm, < .001), fibrofatty plaque volume (27.3 ± 52.2 vs 1.3 ± 3.7 mm, < .001), and necrotic-core plaque volume (2.8 ± 6.4 vs 0.0 ± 0.1 mm, < .001). . After propensity-score matching, 23% of patients with ACS had CAC. Patients with CAC in the ACS and control groups showed significant differences in volumes of noncalcified plaque components. . Methods that identify and quantify noncalcified plaque forms may help characterize ACS risk in symptomatic patients with CAC.
冠状动脉钙化（CAC）评分用于对急性冠状动脉综合征（ACS）风险进行分层。尽管如此，CAC评分为零（CAC）的患者仍面临非钙化斑块成分带来的风险。本研究的目的是通过与随后发生ACS且CAC评分大于0（CAC）的患者以及随后未发生ACS的CAC患者进行比较，探讨有症状的CAC患者经CT血管造影（CTA）得出的冠状动脉斑块特征，这些患者随后发生了ACS。本研究对先前的前瞻性注册数据进行了二次回顾性分析。国际多中心CONFIRM（临床结果的冠状动脉CT血管造影评估：一项国际多中心研究）注册研究收集了2004年1月至2010年5月接受临床指征冠状动脉CTA的有症状患者的纵向观察数据。ICONIC（通过CT识别的急性冠状动脉综合征）是在CONFIRM内进行的一项巢式队列研究，该研究确定了CTA时无已知冠状动脉疾病（CAD）且随后发生和未发生ACS的患者（即分别为ACS组和对照组），并根据CAD风险因素和CTA上的CAD严重程度按1:1比例进行倾向匹配。目前的ICONIC子研究在ACS组和对照组中选择了均有记录的CAC评分的匹配患者。使用人工智能软件对CTA检查进行分析，以实现自动定量斑块评估。在ACS组中，采用有创血管造影结果来识别罪犯病变。本研究纳入了216例患者（平均年龄55.6岁；91例女性和125例男性），ACS组和对照组各有108例患者。在ACS组中，23%（n = 25）的患者有CAC。在ACS组中，有CAC和无CAC的患者亚组中的罪犯病变在纤维、纤维脂肪或坏死核心斑块体积方面无显著差异（P > 0.05）。在有CAC的亚组中，与对照组患者相比，发生ACS的患者平均（±标准差）纤维斑块体积更大（29.4 ± 42.0 vs 5.5 ± 15.2 mm³，P < 0.001），纤维脂肪斑块体积更大（27.3 ± 52.2 vs 1.3 ± 3.7 mm³，P < 0.001），坏死核心斑块体积更大（2.8 ± 6.4 vs 0.0 ± 0.1 mm³，P < 0.001）。倾向评分匹配后，23%的ACS患者有CAC。ACS组和对照组中有CAC的患者在非钙化斑块成分体积方面存在显著差异。识别和量化非钙化斑块形式的方法可能有助于描述有症状的CAC患者的ACS风险特征。
