Atherosclerosis quantification and cardiovascular risk: the ISCHEMIA trial.

IF 37.6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal Pub Date : 2024-09-29 DOI:10.1093/eurheartj/ehae471

Nick S Nurmohamed, James K Min, Rebecca Anthopolos, Harmony R Reynolds, James P Earls, Tami Crabtree, G B John Mancini, Jonathon Leipsic, Matthew J Budoff, Cameron J Hague, Sean M O'Brien, Gregg W Stone, Jeffrey S Berger, Robert Donnino, Mandeep S Sidhu, Jonathan D Newman, William E Boden, Bernard R Chaitman, Peter H Stone, Sripal Bangalore, John A Spertus, Daniel B Mark, Leslee J Shaw, Judith S Hochman, David J Maron

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Abstract

Background and aims: The aim of this study was to determine the prognostic value of coronary computed tomography angiography (CCTA)-derived atherosclerotic plaque analysis in ISCHEMIA.

Methods: Atherosclerosis imaging quantitative computed tomography (AI-QCT) was performed on all available baseline CCTAs to quantify plaque volume, composition, and distribution. Multivariable Cox regression was used to examine the association between baseline risk factors (age, sex, smoking, diabetes, hypertension, ejection fraction, prior coronary disease, estimated glomerular filtration rate, and statin use), number of diseased vessels, atherosclerotic plaque characteristics determined by AI-QCT, and a composite primary outcome of cardiovascular death or myocardial infarction over a median follow-up of 3.3 (interquartile range 2.2-4.4) years. The predictive value of plaque quantification over risk factors was compared in an area under the curve (AUC) analysis.

Results: Analysable CCTA data were available from 3711 participants (mean age 64 years, 21% female, 79% multivessel coronary artery disease). Amongst the AI-QCT variables, total plaque volume was most strongly associated with the primary outcome (adjusted hazard ratio 1.56, 95% confidence interval 1.25-1.97 per interquartile range increase [559 mm3]; P = .001). The addition of AI-QCT plaque quantification and characterization to baseline risk factors improved the model's predictive value for the primary outcome at 6 months (AUC 0.688 vs. 0.637; P = .006), at 2 years (AUC 0.660 vs. 0.617; P = .003), and at 4 years of follow-up (AUC 0.654 vs. 0.608; P = .002). The findings were similar for the other reported outcomes.

Conclusions: In ISCHEMIA, total plaque volume was associated with cardiovascular death or myocardial infarction. In this highly diseased, high-risk population, enhanced assessment of atherosclerotic burden using AI-QCT-derived measures of plaque volume and composition modestly improved event prediction.

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动脉粥样硬化量化与心血管风险：ISCHEMIA 试验。

背景与目的本研究旨在确定 ISCHEMIA 中冠状动脉计算机断层扫描（CCTA）得出的动脉粥样硬化斑块分析的预后价值：对所有可用的基线 CCTA 进行动脉粥样硬化成像定量计算机断层扫描 (AI-QCT)，以量化斑块的体积、组成和分布。在中位随访 3.3 年（四分位间范围为 2.2-4.4）期间，采用多变量 Cox 回归法检测基线风险因素（年龄、性别、吸烟、糖尿病、高血压、射血分数、既往冠心病、估计肾小球滤过率和他汀类药物使用情况）、病变血管数量、AI-QCT 确定的动脉粥样硬化斑块特征与心血管死亡或心肌梗死这一复合主要结局之间的关联。通过曲线下面积（AUC）分析比较了斑块量化对风险因素的预测价值：3711名参与者（平均年龄64岁，21%为女性，79%患有多支冠状动脉疾病）提供了可分析的CCTA数据。在 AI-QCT 变量中，斑块总体积与主要结果的相关性最强（调整后危险比 1.56，95% 置信区间 1.25-1.97 per interquartile range increase [559 mm3]; P = .001）。在基线风险因素的基础上增加 AI-QCT 斑块定量和定性，可提高模型对 6 个月主要结果（AUC 0.688 vs. 0.637；P = .006）、2 年（AUC 0.660 vs. 0.617；P = .003）和 4 年随访（AUC 0.654 vs. 0.608；P = .002）的预测价值。其他报告的结果也与此类似：结论：在 ISCHEMIA 中，斑块总体积与心血管死亡或心肌梗死有关。在这一高疾病、高风险人群中，使用 AI-QCT 导出的斑块体积和组成测量值加强对动脉粥样硬化负担的评估，可适度改善事件预测。

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来源期刊

European Heart Journal 医学-心血管系统

CiteScore

39.30

自引率

6.90%

发文量

3942

审稿时长

1 months

期刊介绍： The European Heart Journal is a renowned international journal that focuses on cardiovascular medicine. It is published weekly and is the official journal of the European Society of Cardiology. This peer-reviewed journal is committed to publishing high-quality clinical and scientific material pertaining to all aspects of cardiovascular medicine. It covers a diverse range of topics including research findings, technical evaluations, and reviews. Moreover, the journal serves as a platform for the exchange of information and discussions on various aspects of cardiovascular medicine, including educational matters. In addition to original papers on cardiovascular medicine and surgery, the European Heart Journal also presents reviews, clinical perspectives, ESC Guidelines, and editorial articles that highlight recent advancements in cardiology. Additionally, the journal actively encourages readers to share their thoughts and opinions through correspondence.