Coronary Atherosclerotic Precursors of Acute Coronary Syndromes

被引：261

作者：

Chang, Hyuk-Jae ^{[1
]}

Lin, Fay Y. ^{[2
]}

Lee, Sang-Eun ^{[1
]}

Andreini, Daniele ^{[3
]}

Bax, Jeroen ^{[4
]}

Cademartiri, Filippo ^{[5
]}

Chinnaiyan, Kavitha ^{[6
]}

Chow, Benjamin J. W. ^{[7
]}

Conte, Edoardo ^{[3
]}

Cury, Ricardo C. ^{[8
]}

Feuchtner, Gudrun ^{[9
]}

Hadamitzky, Martin ^{[10
]}

Kim, Yong-Jin ^{[11
]}

Leipsic, Jonathon ^{[12
]}

Maffei, Erica ^{[13
]}

Marques, Hugo ^{[14
]}

Plank, Fabian ^{[9
]}

Pontone, Gianluca ^{[3
]}

Raff, Gilbert L. ^{[6
]}

van Rosendael, Alexander R. ^{[4
]}

Villines, Todd C. ^{[15
]}

Weirich, Harald G. ^{[9
]}

Al'Aref, Subhi J. ^{[2
]}

Baskaran, Lohendran ^{[2
]}

Cho, Iksung ^{[1
,2
,16
]}

Danad, Ibrahim ^{[17
]}

Han, Donghee ^{[1
,2
]}

Heo, Ran ^{[18
]}

Lee, Ji Hyun ^{[1
,2
]}

Rivzi, Asim ^{[2
,19
]}

Stuijfzand, Wijnand J. ^{[2
]}

Gransar, Heidi ^{[20
]}

Lu, Yao ^{[2
]}

Sung, Ji Min ^{[1
]}

Park, Hyung-Bok ^{[1
]}

Berman, Daniel S. ^{[20
]}

Budoff, Matthew J. ^{[21
]}

Samady, Habib ^{[22
]}

Shaw, Leslee J. ^{[22
]}

Stone, Peter H. ^{[23
]}

Virmani, Renu ^{[24
]}

Narula, Jagat ^{[25
,26
]}

Min, James K. ^{[2
]}

机构：

[1] Yonsei Univ, Severance Cardiovasc Hosp, Integrat Cardiovasc Imaging Res Ctr, Div Cardiol,Coll Med, Seoul, South Korea

[2] New York Presbyterian Hosp & Weill Cornell Med, Dept Radiol, Dalio Inst Cardiovasc Imaging, New York, NY USA

[3] Univ Milan, Centro Cardiol Monzino, Dept Clin Sci & Community Hlth, IRCCS, Milan, Italy

[4] Leiden Univ, Med Ctr, Heart Lung Ctr, Dept Cardiol, Leiden, Netherlands

[5] IRCCS, SDN, Cardiovasc Imaging Ctr, Naples, Italy

[6] William Beaumont Hosp, Dept Cardiol, Royal Oak, MI USA

[7] Univ Ottawa, Dept Med & Radiol, Ottawa, ON, Canada

[8] Baptist Cardiac & Vasc Inst, Miami, FL USA

[9] Med Univ Innsbruck, Dept Radiol, Innsbruck, Austria

[10] German Heart Ctr Munich, Dept Radiol & Nucl Med, Munich, Germany

[11] Seoul Natl Univ, Seoul Natl Univ Hosp, Coll Med, Seoul, South Korea

[12] Univ British Columbia, Dept Med & Radiol, Vancouver, BC, Canada

[13] ASUR Marche, Dept Radiol, Area Vasta 1, Urbino, Italy

[14] Hosp Luz, Unit Cardiovasc Imaging, UNICA, Lisbon, Portugal

[15] Walter Reed Natl Mil Ctr, Cardiol Serv, Bethesda, MD USA

[16] Chung Ang Univ Hosp, Seoul, South Korea

[17] Vrije Univ Amsterdam, Med Ctr, Amsterdam, Netherlands

[18] Univ Ulsan, Coll Med, Asan Med Ctr, Seoul, South Korea

[19] Mayo Clin, Dept Radiol, Rochester, MN USA

[20] Cedars Sinai Med Ctr, Dept Imaging & Med, Los Angeles, CA 90048 USA

[21] Los Angeles Biomed Res Inst, Dept Med, Torrance, CA USA

[22] Emory Univ, Sch Med, Div Cardiol, Atlanta, GA USA

[23] Brigham & Womens Hosp, Div Cardiovasc Med, 75 Francis St, Boston, MA 02115 USA

[24] CVPath Inst, Gaithersburg, MD USA

[25] Icahn Sch Med Mt Sinai, Mt Sinai Heart, Zena & Michael Wiener Cardiovascular Inst, New York, NY 10029 USA

[26] Marie Josee & Henry R Kravis Ctr Cardiovasc Hlth, New York, NY USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2018年 / 71卷 / 22期

基金：

美国国家卫生研究院; 新加坡国家研究基金会;

关键词：

acute coronary syndrome; atherosclerosis; clinical outcome; coronary artery disease; coronary computed tomography angiography; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; PROPENSITY SCORE METHODS; INTRAVASCULAR ULTRASOUND; ARTERY-DISEASE; CT ANGIOGRAPHY; PLAQUE CHARACTERIZATION; MYOCARDIAL-INFARCTION; SCCT GUIDELINES; CULPRIT PLAQUE; RISK;

D O I：

10.1016/j.jacc.2018.02.079

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The association of atherosclerotic features with first acute coronary syndromes (ACS) has not accounted for plaque burden. OBJECTIVES The purpose of this study was to identify atherosclerotic features associated with precursors of ACS. METHODS We performed a nested case-control study within a cohort of 25,251 patients undergoing coronary computed tomographic angiography (CTA) with follow-up over 3.4 +/- 2.1 years. Patients with ACS and nonevent patients with no prior coronary artery disease (CAD) were propensity matched 1:1 for risk factors and coronary CTA-evaluated obstructive (>= 50%) CAD. Separate core laboratories performed blinded adjudication of ACS and culprit lesions and quantification of baseline coronary CTA for percent diameter stenosis (%DS), percent cross-sectional plaque burden (PB), plaque volumes (PVs) by composition (calcified, fibrous, fibrofatty, and necrotic core), and presence of high-risk plaques (HRPs). RESULTS We identified 234 ACS and control pairs (age 62 years, 63% male). More than 65% of patients with ACS had nonobstructive CAD at baseline, and 52% had HRP. The %DS, cross-sectional PB, fibrofatty and necrotic core volume, and HRP increased the adjusted hazard ratio (HR) of ACS (1.010 per %DS, 95% confidence interval [CI]: 1.005 to 1.015; 1.008 per percent cross-sectional PB, 95% CI: 1.003 to 1.013; 1.002 per mm(3) fibrofatty plaque, 95% CI: 1.000 to 1.003; 1.593 per mm3 necrotic core, 95% CI: 1.219 to 2.082; all p < 0.05). Of the 129 culprit lesion precursors identified by coronary CTA, three-fourths exhibited <50% stenosis and 31.0% exhibited HRP. CONCLUSIONS Although ACS increases with %DS, most precursors of ACS cases and culprit lesions are nonobstructive. Plaque evaluation, including HRP, PB, and plaque composition, identifies high-risk patients above and beyond stenosis severity and aggregate plaque burden. Published by Elsevier on behalf of the American College of Cardiology Foundation.

引用

页码：2511 / 2522

页数：12

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