冠状动脉CT血管造影评估的斑块负荷在已知冠状动脉疾病中的预后价值。

Prognostic value of plaque burden assessed by coronary CT angiography in known coronary artery disease.

作者信息

Cho Sung Woo, Torbati Tina, Lee Su Nam, Gransar Heidi, Dey Damini, Slomka Piotr, Hayes Sean W, Friedman John D, Thomson Louise E J, Rozanski Alan, Park Rebekah, Berman Daniel S, Han Donghee

机构信息

Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea.

Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

出版信息

J Cardiovasc Comput Tomogr. 2025 Jun 7. doi: 10.1016/j.jcct.2025.05.239.

DOI:10.1016/j.jcct.2025.05.239

PMID:40484795

Abstract

BACKGROUND

We aimed to investigate in patients with known coronary artery disease (CAD) whether plaque burden assessed by coronary computed tomography angiography (CCTA) can predict subsequent all-cause mortality (ACM).

METHODS

Consecutive patients with known CAD who underwent CCTA and coronary artery calcium (CAC) scans for CAD evaluation were enrolled. Known CAD was defined as history of myocardial infarction (MI) or percutaneous coronary intervention (PCI). Plaque burden was assessed by CAC (categorized as 0-100, 101-300, 301-999, ≥1000), degree of stenosis (DS) (0-24 %, 25-49 %, 50-69 %, and ≥70 %) and segmental involvement score (SIS) (≤2, 3-4, 5-7, and ≥8) on CCTA. Multivariable Cox regression analysis was used to determine the association between plaque burden and ACM.

RESULTS

963 patients were included (age 66.1 ± 11.5, 72.0 % male) of whom 707 had PCI, 586 had MI, and 330 had both. During median follow-up of 3.0 years (interquartile range 1.0-6.5), 91 patients (9.4 %) died. By Kaplan-Meier analysis, higher CAC score was associated with a higher risk of ACM (p < 0.001), but DS and SIS were not. In multivariable Cox regression analysis, CAC scores 301-999 (HR:3.10, 95%CI:1.23-7.80, p = 0.017) and ≥1000 (HR:5.81, 95%CI:2.25-15.04, p < 0.001) along with age, current smoking, and aspirin use were independently associated with increased risk of ACM, but DS and SIS were not.

CONCLUSION

In patients with known CAD undergoing CCTA, CAC score>300 was an independent predictor of ACM. CAC may provide additional guidance for the intensity of secondary preventive treatments than the degree of residual stenosis or the number of segments with CAD.

摘要

背景

我们旨在研究在已知冠状动脉疾病（CAD）的患者中，通过冠状动脉计算机断层扫描血管造影（CCTA）评估的斑块负荷是否能预测随后的全因死亡率（ACM）。

方法

纳入连续的已知CAD患者，这些患者接受了CCTA和冠状动脉钙化（CAC）扫描以评估CAD。已知CAD定义为心肌梗死（MI）或经皮冠状动脉介入治疗（PCI）病史。通过CAC（分为0 - 100、101 - 300、301 - 999、≥1000）、狭窄程度（DS）（0 - 24%、25 - 49%、50 - 69%和≥70%）以及CCTA上的节段累及评分（SIS）（≤2、3 - 4、5 - 7和≥8）来评估斑块负荷。采用多变量Cox回归分析来确定斑块负荷与ACM之间的关联。

结果

共纳入963例患者（年龄66.1±11.5岁，72.0%为男性），其中707例接受了PCI，586例有MI病史，330例两者均有。在中位随访3.0年（四分位间距1.0 - 6.5年）期间，91例患者（9.4%）死亡。通过Kaplan - Meier分析，较高的CAC评分与较高的ACM风险相关（p<0.001），但DS和SIS则不然。在多变量Cox回归分析中，CAC评分301 - 999（HR：3.10，95%CI：1.23 - 7.80，p = 0.017）和≥1000（HR：5.81，95%CI：2.25 - 15.04，p<0.001）以及年龄、当前吸烟状态和阿司匹林使用情况与ACM风险增加独立相关，但DS和SIS并非如此。