Relationship Between Coronary Artery Calcium Score and Vulnerability of Culprit Plaque Assessed by OCT in Patients With Established Coronary Artery Disease.

IF 7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation: Cardiovascular Imaging Pub Date : 2025-01-01 Epub Date: 2024-12-20 DOI:10.1161/CIRCIMAGING.124.017099

Daichi Fujimoto, Eisuke Usui, Rocco Vergallo, Daisuke Kinoshita, Keishi Suzuki, Takayuki Niida, Marco Covani, Iris McNulty, Hang Lee, Hiromasa Otake, Junya Shite, Maros Ferencik, Damini Dey, Tsunekazu Kakuta, Ik-Kyung Jang

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Abstract

Background: Coronary artery calcium score (CACS) is widely used for risk stratification. However, in patients with established coronary artery disease, its clinical implication and relationship with plaque vulnerability are unclear. We sought to correlate the CACS and plaque vulnerability assessed by optical coherence tomography.

Methods: Patients with coronary artery disease who had CACS and optical coherence tomography before percutaneous coronary intervention were included. Patients were divided into 5 groups based on CACS: CACS of 0, 1 to 99, 100 to 399, 400 to 999, and ≥1000. Optical coherence tomography-derived vulnerable features in culprit plaque were compared between the groups.

Results: In 460 patients, the prevalence of lipid-rich plaque, macrophage, and cholesterol crystal significantly differed among the 5 groups, being lowest in the patients with a CACS of 0. The prevalence of thin-cap fibroatheroma tended to be lower in those with a CACS of 0. No significant difference in vulnerable features was observed between the 4 groups with CACS >0. In the 2-group comparison between the group with a CACS of 0 and the other 4 groups combined, the prevalence of lipid-rich plaque (60.5% versus 85.9%; P<0.001), macrophage (48.8% versus 74.1%; P<0.001), thin-cap fibroatheroma (16.3% versus 35.0%; P=0.013), and cholesterol crystal (11.6% versus 32.9%; P=0.004) was significantly lower in the patients with CACS of 0. CACS of 0 was independently negatively associated with lipid-rich plaque, macrophage, thin-cap fibroatheroma, and cholesterol crystal after adjustment for patient characteristics.

Conclusions: Patients with a CACS of 0 have a significantly lower prevalence of vulnerable plaque features compared with those with CACS >0 in patients with established coronary artery disease.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04523194.

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冠脉病变患者冠状动脉钙化评分与罪犯斑块易损性的关系

背景：冠状动脉钙评分（CACS）被广泛用于危险分层。然而，在确诊的冠状动脉疾病患者中，其临床意义及其与斑块易感性的关系尚不清楚。我们试图通过光学相干断层扫描评估CACS和斑块易损性之间的关系。方法：纳入经皮冠状动脉介入治疗前行CACS和光学相干断层扫描的冠心病患者。根据患者的CACS分为5组：CACS为0、1 ~ 99、100 ~ 399、400 ~ 999和≥1000。比较两组间罪犯斑块的光学相干断层扫描易损特征。结果：460例患者中，富脂斑块、巨噬细胞、胆固醇晶体的患病率在5组间差异有统计学意义，以CACS为0的患者最低。在CACS为0的人群中，薄帽纤维粥样硬化的患病率往往较低。各组间易损特征差异无统计学意义。在两组比较中，CACS为0的组与其他4组的合并，富脂斑块的患病率(60.5% vs 85.9%；PPP=0.013)，胆固醇晶体(11.6% vs 32.9%；P=0.004)明显低于CACS为0的患者。调整患者特征后，CACS为0与富脂斑块、巨噬细胞、薄帽纤维粥样瘤和胆固醇晶体呈独立负相关。结论：在已确诊的冠状动脉疾病患者中，CACS为0的患者易损斑块特征的发生率明显低于CACS为>的患者。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT04523194。

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来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.