Cortés Carlos, Ruiz-Ruiz Julio, Rivero Fernando, López-Palop Ramón, Jiménez Octavio, Freites Alfonso, Gonçalves-Ramírez Luis R, Nadal María Rosario Ortas, Blasco Sara, García-Gómez Mario, Fernández Clara, Scorpiglione Luca, Calvar J Alberto San Román, Amat-Santos Ignacio J
Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, España Servicio de Cardiología Hospital Clínico Universitario de Valladolid Valladolid España.
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Madrid España.
REC Interv Cardiol. 2025 Jan 29;7(2):109-114. doi: 10.24875/RECIC.M24000498. eCollection 2025 Apr-Jun.
The use of coronary physiology is essential to guide revascularization in patients with stable coronary artery disease. However, some patients without significant angiographic coronary artery disease will experience cardiovascular events at the follow-up. This study aims to determine the prognostic value of the global plaque volume (GPV) in patients with stable coronary artery disease without functionally significant lesions at a 5-year follow-up.
We conducted a multicenter, observational, and retrospective cohort study with a 5-year follow-up. A total of 277 patients without significant coronary artery disease treated with coronary angiography in 2015 due to suspected stable coronary artery disease were included in the study. The 3 coronary territories were assessed using quantitative flow ratio, calculating the GPV by determining the difference between the luminal volume and the vessel theoretical reference volume.
The mean GPV was 170.5 mm. A total of 116 patients (42.7%) experienced major adverse cardiovascular events (MACE) at the follow-up, including cardiac death (11%), myocardial infarction (2.6%), and unexpected hospital admissions (38.1%). Patients with MACE had a significantly higher GPV (231.6 mm vs 111.8 mm; < .001). The optimal GPV cut-off point for predicting events was 44 mm. Furthermore, in the multivariate analysis conducted, plaque volume, diabetes, hypertension, age, dyslipidemia, smoking, age, and GPV > 44 mm turned out to be independent predictors of MACE.
GPV, calculated from the three-dimensional reconstruction of the coronary tree, is an independent predictor of events in patients with stable coronary artery disease without significant lesions. A GPV > 44 mm is an optimal cut-off point for predicting events.
冠状动脉生理学的应用对于指导稳定型冠状动脉疾病患者的血运重建至关重要。然而，一些冠状动脉造影无明显冠状动脉疾病的患者在随访中会发生心血管事件。本研究旨在确定在5年随访中，全球斑块体积（GPV）对无功能意义性病变的稳定型冠状动脉疾病患者的预后价值。
我们进行了一项为期5年随访的多中心、观察性、回顾性队列研究。本研究纳入了2015年因疑似稳定型冠状动脉疾病接受冠状动脉造影且无明显冠状动脉疾病的277例患者。使用定量血流比率评估三个冠状动脉区域，通过确定管腔体积与血管理论参考体积之间的差异来计算GPV。
平均GPV为170.5mm。共有116例患者（42.7%）在随访中发生主要不良心血管事件（MACE），包括心源性死亡（11%）、心肌梗死（2.6%）和意外住院（38.1%）。发生MACE的患者的GPV显著更高（231.6mm对111.8mm；P<0.001）。预测事件的最佳GPV切点为44mm。此外，在进行的多变量分析中，斑块体积、糖尿病、高血压、年龄、血脂异常、吸烟、年龄以及GPV>44mm被证明是MACE的独立预测因素。
根据冠状动脉树的三维重建计算得出的GPV是无明显病变的稳定型冠状动脉疾病患者事件的独立预测因素。GPV>44mm是预测事件的最佳切点。
