Zheng Jianan, Hou Zhihui, Gao Yang, Yin Weihua, Ma Yanan, An Yunqiang, Wang Yang, Song Lei, Lu Bin
Department of Radiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China.
Am J Prev Cardiol. 2025 Apr 22;22:100995. doi: 10.1016/j.ajpc.2025.100995. eCollection 2025 Jun.
The purpose of this study was to compare coronary computed tomography angiography (CCTA) and guideline-recommended clinical risk assessment for the value in statin allocation in outpatients with suspected coronary artery disease (CAD).
For the 7860 eligible outpatients with suspected CAD who underwent CCTA, we evaluate hard atherosclerotic cardiovascular disease (ASCVD) and major adverse cardiac and cerebrovascular event (MACCE) stratified by guideline-recommended clinical risk assessment, and CCTA. For intermediate risk patients, we also compared the predictive value of CCTA and CAC.
Over a median follow-up period of 3.6 years, a total of 83 (1.1 %) hard ASCVD and 170 (2.2 %) MACCE occurred. The event rate increased with both the intensity of statin recommendation (e.g., hard ASCVD: 1.5 per 1000 person-years [PY] for statin not recommended, 4.1 per 1000 PY for moderate-intensity statin, and 8.9 per 1000 PY for high-intensity statin) and the severity of coronary stenosis (e.g., hard ASCVD: 0.7 per 1000 PY for no plaque, 5.1 per 1000 PY for non-obstructive CAD, and 11.2 per 1000 PY for obstructive CAD). When stratified by CCTA, higher intensity statin recommendation was not a statistically significant independent risk factor, both for hard ASCVD and MACCE. For the predictive value of hard ASCVD in intermediate risk patients, there was no statistically significant difference between CCTA and CAC (the area under the receiver operating characteristic curve: 0.692 versus 0.702; = 0.78).
CCTA played a more important role in statin allocation compared to guideline-recommended clinical risk assessment in outpatients who underwent CCTA.
本研究旨在比较冠状动脉计算机断层扫描血管造影（CCTA）与指南推荐的临床风险评估在疑似冠心病（CAD）门诊患者他汀类药物分配中的价值。
对于7860例接受CCTA检查的符合条件的疑似CAD门诊患者，我们根据指南推荐的临床风险评估和CCTA对严重动脉粥样硬化性心血管疾病（ASCVD）和主要不良心脑血管事件（MACCE）进行分层评估。对于中度风险患者，我们还比较了CCTA和冠状动脉钙化（CAC）的预测价值。
在中位随访期3.6年期间，共发生83例（1.1%）严重ASCVD和170例（2.2%）MACCE。事件发生率随他汀类药物推荐强度（例如，严重ASCVD：不推荐使用他汀类药物时为每1000人年1.5例，中度强度他汀类药物时为每1000人年4.1例，高强度他汀类药物时为每1000人年8.9例）和冠状动脉狭窄严重程度（例如，严重ASCVD：无斑块时为每1000人年0.7例，非阻塞性CAD时为每1000人年5.1例，阻塞性CAD时为每1000人年11.2例）而增加。当按CCTA分层时，对于严重ASCVD和MACCE，更高强度的他汀类药物推荐不是统计学上显著的独立危险因素。对于中度风险患者中严重ASCVD的预测价值，CCTA和CAC之间没有统计学上的显著差异（受试者工作特征曲线下面积：分别为0.692和0.702；P = 0.78）。
在接受CCTA检查的门诊患者中,与指南推荐的临床风险评估相比，CCTA在他汀类药物分配中发挥了更重要的作用。
