The high-risk criteria low-attenuation plaque <60 HU and the napkin-ring sign are the most powerful predictors of MACE: a long-term follow-up study

被引：102
作者：
Feuchtner, Gudrun [1 ]
Kerber, Johannes [1 ]
Burghard, Philipp [1 ]
Dichtl, Wolfgang [2 ]
Friedrich, Guy [2 ]
Bonaros, Nikolaos [3 ]
Plank, Fabian [1 ,2 ]
机构：
[1] Innsbruck Med Univ, Dept Radiol, Anichstr 35, A-6020 Innsbruck, Austria
[2] Innsbruck Med Univ, Dept Internal Med 3, Cardiol, Innsbruck, Austria
[3] Innsbruck Med Univ, Dept Cardiac Surg, Innsbruck, Austria
来源：
EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING | 2017年 / 18卷 / 07期
关键词：
coronary artery disease; atherosclerosis; high-risk plaque; computed tomography; major adverse cardiac events (MACE); CORONARY CT ANGIOGRAPHY; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; NON-CALCIFIED PLAQUE; ACUTE CHEST-PAIN; ITERATIVE RECONSTRUCTION; MYOCARDIAL-INFARCTION; HEART-ASSOCIATION; AMERICAN-COLLEGE; ARTERY STENOSIS; TASK-FORCE;
D O I：
10.1093/ehjci/jew167
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Aims To assess the prognostic value of coronary CT angiography (CTA) for prediction of major adverse cardiac events (MACE) over a long-term follow-up period. Methods and results A total of 1469 low-to-intermediate-risk patients (65.9 years; 44.2% females) were included in our prospective cohort study. CTA was evaluated for (i) stenosis severity (minimal <10%; mild <50%; moderate 50-70%; severe >70%), (ii) plaque types (calcified, mixed dominantly calcified, mixed dominantly non-calcified, non-calcified), and (iii) high-risk plaque criteria [low-attenuation plaque (LAP) quantified by HU, napkin-ring (NR) sign, spotty calcification,3 mm, and remodelling index (RI)]. Over a follow-up of mean 7.8 years, MACE rate was 41 (2.8%) and 0% in patients with negative CTA. MACE rate increased along with stenosis severity by CTA (from 1.3 to 7.8%) (P < 0.001) and was higher in T3/T4 plaques than in T2/T1 (7.8 vs. 1.9%; P < 0.0001). LAP density was lower (35.2 HU +/- 32 vs. 108.8 HU +/- 53) (P < 0.001) and both NR-sign prevalence with n = 26 (63.4%) vs. n = 40 (28%) and LAP <30, <60, and <90 HU prevalence with 46.3-78% vs. 2.4-7% were higher in the MACE group (P, 0.001). On univariate and unadjusted multivariable proportional Hazards model, LAP <60 HU and NR were the strongest MACE predictors (HR 4.96; 95% CI: 2.0-12.2 and HR 3.85; 95% CI: 1.7-8.6) (P < 0.0001), while spotty calcification (HR 2.2; 95% CI: 1.1-4.3, P < 0.001), stenosis severity, and plaque type (HR 1.5; 95% CI: 1.1-2.3 and HR 1.7; 95% CI: 1.1-2.6) (P<0.001) were less powerful. After adjusting for risk factors, CTA stenosis severity, and plaque type, LAP <60 HU and the NR sign remained significant (P < 0.001), while the effect of NR sign was even enhancing. HRP criteria were independent predictors from other risk factors. Conclusion Prognosis is excellent over a long-term period if CTA is negative and worsening with an increasing non-calcifying plaque component. LAP <60 HU and NR sign are the most powerful MACE predictors.
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收藏
页码：772 / 779
页数：8
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